Nephrol Dial Transplant. 2011 Jul;26(7):2087-91. doi: 10.1093/ndt/gfr181. Epub 2011 May 4.
The question when to initiate dialysis is attracting increasing attention. In recent years, there has been a tendency to initiate dialysis earlier in terms of estimated glomerular filtration rate (eGFR) in an attempt to achieve better patient outcomes. However, several observational studies and one randomized controlled trial have found no benefit for early dialysis initiation. On the contrary, they have found that starting dialysis with a higher eGFR is associated with increased mortality. These studies need to be carefully interpreted in light of their reliance on eGFR to estimate kidney function at dialysis initiation. The decision to start dialysis should not be based solely on a predefined eGFR value, but more importantly on a careful clinical assessment of the individual patient.
何时开始透析的问题正引起越来越多的关注。近年来，为了获得更好的患者结局，人们倾向于根据估算肾小球滤过率（eGFR）更早地开始透析。然而，一些观察性研究和一项随机对照试验发现，早期透析并没有带来获益。相反，他们发现较高的 eGFR 开始透析与死亡率增加相关。这些研究需要结合其对透析起始时 eGFR 估计肾功能的依赖进行仔细解读。开始透析的决定不应仅仅基于预设的 eGFR 值，而更重要的是对个体患者进行仔细的临床评估。
