Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
Pediatr Nephrol. 2020 Sep;35(9):1593-1600. doi: 10.1007/s00467-019-04333-4. Epub 2019 Aug 15.
The best time to start chronic dialysis during the course of CKD stage 5 is controversial. The first randomised control trial of dialysis initiation either in early or late CKD stage 5 in adults (IDEAL study), and 3 studies from the two largest paediatric registries, the U.S. Renal Data System (USRDS) and the European Society of Paediatric Nephrology (ESPN) Registry, have now provided us with evidence to guide us in this important decision-making process. The message 'no benefit from early start of dialysis' is the conclusion from all four studies. However, what are the limitations of these studies? Can GFR be assessed at CKD stages 4 and 5? What are the factors used to assess the benefit of early or late start? These issues are discussed in this review.
在慢性肾脏病 5 期的病程中开始慢性透析的最佳时机存在争议。第一项关于在成人慢性肾脏病 5 期的早期或晚期开始透析的随机对照试验（IDEAL 研究），以及来自美国肾脏数据系统（USRDS）和欧洲儿科肾脏病学会（ESPN）登记处这两个最大儿科登记处的 3 项研究，现在为我们提供了指导这一重要决策过程的证据。这四项研究的结论是“早期开始透析没有益处”。然而，这些研究有哪些局限性？肾小球滤过率（GFR）能否在慢性肾脏病 4 期和 5 期进行评估？评估早期或晚期开始的益处时使用了哪些因素？这些问题在本文中进行了讨论。
