The IDEAL Trial - Initiating Dialysis Early And Late

在过去，当终末期肾衰患者的剩余肾功能恶化到正常的5-10%以下时，就可以通过透析进行肾脏替代治疗。近年来，在肾功能衰竭的早期阶段提供透析治疗的趋势有所增加，澳大利亚超过20%的透析患者(在某些亚组中高达35%)现在当他们的剩余肾功能超过10%时开始接受透析治疗。这一变化的发生是因为未经证实的信念，即早期透析可能与更好的健康结果相关。然而，透析治疗与并发症有关，而且非常昂贵。因此，重要的是要确定尽早开始透析的健康和经济后果。理想的试验(早期和后期启动透析)是在澳大利亚和新西兰的许多肾脏单位进行的大型多中心研究，该研究将确定在剩余肾功能在10%至14%之间或在正常情况下的5%至7%时开始透析是否更好，就健康结果和总治疗成本而言。

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.