The IDEAL Trial - Initiating Dialysis Early And Late

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Kidney replacement therapy by dialysis has in the past been provided for patients with endstage renal failure once their remaining kidney function has deterioriated to less than 5-10% of normal. There has been an increasing trend in recent years to offer dialysis therapy at an earlier stage of kidney failure, such that more than 20% of dialysis patients in Australia (and up to 35% in some subgroups) now commence that therapy when their remaining kidney function is greater than 10%. This change has occurred because of the unproven belief that earlier dialysis may be associated with a better health outcome. However, dialysis treatment is associated with complications and it is very expensive. Therefore, it is important to determine the health and economic consequences of commencing dialysis early rather than late. The IDEAL trial (Initiating Dialysis Early And Late) is a large multi-centre study being conducted in many renal units in Australia and New Zealand, which will determine whether it is better, in terms of health outcomes and total cost of treatment, to commence dialysis at a time when remaining kidney function is between 10 and 14% or between 5 and 7% of normal.