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Nephrol Dial Transplant (2002) 17: 1550-1552
© 2002 European Renal Association-European Dialysis and Transplant Association

Editorial Comments

Initiation of dialysis—is the problem solved by NECOSAD?

Norbert Lameire, Wim Van Biesen and Raymond Vanholder

Renal Division, Department of Medicine, University Hospital, 185, De Pintelaan, 9000 Ghent, Belgium

Keywords: initiation of RRT; Kt/Vurea; NECOSAD

The first 150 words of the full text of this article appear below.

Although more than four decades have passed since the introduction of maintenance haemodialysis in 1960 [1], there are no uniform objective criteria regarding the level of renal function at which renal replacement therapy (RRT) should be initiated. Nephrologists initiate RRT in most cases on the basis of the observation of uraemic symptoms and changes of laboratory parameters, such as plasma creatinine concentration and/or creatinine clearance [2]. However, the occurrence of uraemic symptoms varies from patient to patient [3], so there is substantial variation in the timing of initiation of RRT [4–6]. For example, the study by Obrador et al. [6] revealed that a substantial fraction of patients (23%) in the USA started dialysis at levels of predicted glomerular filtration rate (GFR) below 5 ml/min.

At what level of GFR is RRT to be started? Recent recommendations

In an attempt to improve the quality and outcome of dialysis care, the US . . . [Full Text of this Article]

The results of the NECOSAD Registry

What are the caveats?

The problem of lead-time bias

Statistical problems with the NECOSAD study

Are the results definitive?


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