2006;47:78–87. (Level 3)   7. Jungers P, et al. Nephrol Dial Transplant. 2001;16:2357–64. (Level 4)   8. Bayliss EA, et al. Clin J Am Soc Nephrol. 2011;6:704–10. (Level 4)   9. Barrett BJ, et al. Clin LY2874455 J Am Soc Nephrol. 2011;6:1241–7. (Level 2)   10. Kessler M, et al. Am J Kidney Dis. 2003;42:474–85. (Level 4)   11. Kinchen KS,

et al. Ann Intern Med. 2002;137:479–86. (Level 4)   12. Roderick P, et al. Nephrol Dial Transplant. 2002;17:1252–9. (Level 4)   What are the criteria for initiating dialysis to improve the survival of patients with CKD? In the past, early initiation of dialysis was suggested as a means to improve survival, and there was a tendency to start dialysis even though the eGFR was relatively high. However, in recent years, there have been several negative reports on the early initiation of dialysis selleck compound and better survival after later dialysis initiation. The negative results of the IDEAL study, which was an RCT that compared early with late initiation, were not cited in the CKD clinical practice guidelines 2009 in Japan. Consensus among various related societies in Japan and several overseas guidelines have suggested that the initiation of dialysis is required in patients with progressive

renal Cisplatin cell line dysfunction with an eGFR value of <15 ml/min/1.73 m2 and clear positive symptoms of uremia. According to recent observational studies (e.g. ERA-EDTA registry, USRDS registry), patients who were initiated on dialysis at an eGFR value of approximately 5–10 ml/min/1.73 m2 showed a significantly better survival, compared with those who were initiated at a value of less than 5 or more than 10 ml/min/1.73 m2. In addition, an analysis of Japanese patients enrolled in the JSDT registry showed that initiation at

an eGFR value of <8 ml/min/1.73 m2 was associated with a better prognosis and initiation at an eGFR value of <2 ml/min/1.73 m2 was associated with a poorer prognosis. The results of the IDEAL study, the only RCT on this topic, were published in 2010. In this study, a comparison of survival between an early initiation group (eGFR of 10–14 ml/min/1.73 m2) and a late initiation group (5–7 ml/min/1.73 m2) was conducted. However, better results for all-cause mortality Sinomenine were not obtained in the early initiation group. Bibliography 1. Stel VS, et al. Nephrol Dial Transplant. 2009;24:3175–82. (Level 4)   2. Wright S, et al. Clin J Am Soc Nephrol. 2010;5:1828–35. (Level 4)   3. Cooper BA, et al. N Engl J Med. 2010;363:609–19. (Level 2)   4. Yamagata K, et al. Ther Apher Dial. 2012;16:54–62. (Level 4)   5. Wagner M, et al. Am J Kidney Dis. 2011;57:894–902. (Level 4)   6. Couchoud C, et al. Nephrol Dial Transplant. 2009;24:1553–61. (Level 4)   7. Portoles J, et al. Perit Dial Int. 2009;29:150–7. (Level 4)   8. Shafi T, et al. Am J Kidney Dis. 2010;56:348–58. (Level 4)   9. Yamagata K, et al.