Glomerular Filtration Rate and Patient Prognosis in Diabetic Patients with End-stage Renal Disease

When to initiate dialysis in patients with end-stage renal disease (ESRD) has been a controversial issue. The current study was designed to determine whether glomerular filtration rate (GFR) at the time of onset of dialysis predicts survival in diabetic ESRD patients. A total of 475 diabetic patients, 330 men and 145 women, who consecutively started dialysis between 1994 and 2001 were included in the study. Mean age at the onset of dialysis was 59 ± 12 (SD) years. Patients were divided into five categories (quintiles) based on the distribution of GFR, estimated using the Modification Diet Renal Disease (MDRD) Study Group equation (MDRD-GFR). The end-point for survival analysis was all-cause death during the follow-up period. Patients were censored at the time of kidney transplantation, loss to follow-up, or on December 31, 2002, whichever occurred first. Five-year survivals for the first to fifth GFR quintiles were 61.1, 58.4, 67.3, 63.8, and 68.4%, respectively (p=0.694, logrank test). There were no significant differences in the survival among the five groups based on Cox's proportional hazard analysis. Therefore, MDRD-GFR has little or no predictive value in determining patient survival, and there is insufficient evidence to advocate starting dialysis solely on the basis of MDRD-GFR in diabetic patients with ESRD