Evidence map›Paper›PMID 34844936›Full record

Observational studyBMJ (Clinical research ed.)2021

Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study.

Edouard L Fu, Marie Evans, Juan-Jesus Carrero, Hein Putter, Catherine M Clase, Fergus J Caskey, Maciej Szymczak, Claudia Torino, Nicholas C Chesnaye, Kitty J Jager and 3 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ (Clinical research ed.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
51citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

51 citing papers in PubMed, 5 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Edouard L FuDepartment of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands edfu@bwh.harvard.edu.ORCID 0000-0002-9698-6825
Marie EvansDepartment of Clinical Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Juan-Jesus CarreroDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Hein PutterDepartment of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands.
Catherine M ClaseDepartment of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Fergus J CaskeyPopulation Health Sciences, University of Bristol Medical School, Bristol, UK.
Maciej SzymczakDepartment of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
Claudia TorinoIFC-CNR, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy.
Nicholas C ChesnayeERA-EDTA Registry, Department of Medical Informatics, Academic University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
Kitty J JagerERA-EDTA Registry, Department of Medical Informatics, Academic University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
Christoph WannerDivision of Nephrology, University Hospital of Würzburg, Würzburg, Germany.
Friedo W DekkerDepartment of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands.
Merel van DiepenDepartment of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo identify the optimal estimated glomerular filtration rate (eGFR) at which to initiate dialysis in people with advanced chronic kidney disease.

designNationwide observational cohort study.

settingNational Swedish Renal Registry of patients referred to nephrologists.

participantsPatients had a baseline eGFR between 10 and 20 mL/min/1.73 m

main outcome measuresThe strict design criteria of a clinical trial were mimicked by using the cloning, censoring, and weighting method to eliminate immortal time bias, lead time bias, and survivor bias. A dynamic marginal structural model was used to estimate adjusted hazard ratios and absolute risks for five year all cause mortality and major adverse cardiovascular events (composite of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) for 15 dialysis initiation strategies with eGFR values between 4 and 19 mL/min/1.73 m

resultsAmong 10 290 incident patients with advanced chronic kidney disease (median age 73 years; 3739 (36%) women; median eGFR 16.8 mL/min/1.73 m

conclusionsVery early initiation of dialysis was associated with a modest reduction in mortality and cardiovascular events. For most patients, such a reduction may not outweigh the burden of a substantially longer period spent on dialysis.

Indexed as

AgedCardiovascular DiseasesCohort StudiesFemaleGlomerular Filtration RateHumansMaleNephrologyPractice Patterns, Physicians'Proportional Hazards ModelsRegistriesRenal DialysisRenal Insufficiency, ChronicSwedenTime FactorsTime-to-Treatment

Identifiers

PMID34844936
PMCPMC8628190

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.