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IDEAL
About the Trial
The Initiating Dialysis Early and Late trial randomized 828 patients with progressive CKD to start dialysis at eGFR 10 to 14 versus 5 to 7. Early initiation did not reduce death or cardiovascular events, with mortality of 37.6 versus 36.6 percent, although the early group started dialysis a median of about 6 months sooner. The trial overturned creeping practice of initiating dialysis at ever higher eGFR, driven by observational data suggesting early start helped. IDEAL showed that this trend added months of dialysis without clear benefit. Guidelines shifted toward initiation guided by symptoms and clinical status rather than eGFR alone. Dialysis onset timing became patient centered, sparing months of dialysis for many.
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