ArticleClinical epidemiology2017
Effect of glomerular filtration rate at dialysis initiation on survival in patients with advanced chronic kidney disease: what is the effect of lead-time bias?
Article in Clinical epidemiology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 citations in OpenAlex.
- Update of dialysis initiation timing in end stage kidney disease patients: is it a resolved question? A systematic literature review.BMC nephrology · 2023Pooled it
- Survival of patients who opt for dialysis versus conservative care: a systematic review and meta-analysis.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2022Pooled it
- Resting-state EEG reveals slowing and altered functional connectivity in children and young adults with severe chronic kidney disease.Clinical neurophysiology practice · 2026Article
- Early Versus Late Initiation of Dialysis in CKD Stage 5: Time for a Consensus.Kidney international reports · 2025Review
- Survival rates in comprehensive conservative care compared to dialysis therapy in elderly end-stage kidney disease patients: a propensity score analysis.Renal failure · 2024Article
- Replacement Strategies for Tunneled Hemodialysis Catheters with Complications: A Nationwide Cohort Study.Clinical journal of the American Society of Nephrology : CJASN · 2024Article
- Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study.BMJ (Clinical research ed.) · 2021Observational
- Where to look for the most frequent biases?Nephrology (Carlton, Vic.) · 2020Review
- Higher eGFR at Dialysis Initiation Is Not Associated with a Survival Benefit in Children.Journal of the American Society of Nephrology : JASN · 2019Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeCurrent clinical guidelines recommend to initiate dialysis in the presence of symptoms or signs attributable to kidney failure, often with a glomerular filtration rate (GFR) of 5-10 mL/min/1.73 m MATERIALS AND
methodsA total of 1,143 patients with eGFR data at dialysis initiation and 852 patients with mGFR data were included from the NECOSAD cohort. Cox regression was used to adjust for potential confounders. To examine the effect of lead-time bias, survival was counted from the time of dialysis initiation or from a common starting point (GFR 20 mL/min/1.73 m
resultsWithout lead-time correction, no difference between early and late starters was present based on eGFR (hazard ratio [HR] 1.03, 95% confidence interval [CI] 0.81-1.3). However, after lead-time correction, early initiation showed a survival disadvantage (HR between 1.1 [95% CI 0.82-1.48] and 1.33 [95% CI 1.05-1.68]). Based on mGFR, the potential survival benefit for early starters without lead-time correction (HR 0.8, 95% CI 0.62-1.03) completely disappeared after lead-time correction (HR between 0.94 [95% CI 0.65-1.34] and 1.21 [95% CI 0.95-1.56]). Dialysis start time differed about a year between early and late initiation.
conclusionLead-time bias is not only a methodological problem but also has clinical impact when assessing the optimal kidney function to start dialysis. Therefore, lead-time bias is extremely important to correct for. Taking account of lead-time bias, this controlled study showed that early dialysis initiation (eGFR >7.9, mGFR >6.6 mL/min/1.73 m
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