RESUMO
Objective To investigate the relationship between glomerular filtration rate (GFR) at the initiation of dialysis and the prognosis of chronic renal failure (CRF) patients via systematic review and meta analysis. Methods Literature retrieval was conducted using “dialysis initiation”, “prognosis/mortality/survival”, “timing”, and “CKD/CRF/ESRD” as key words in databases including PubMed, Medline, EMBASE and Cochrane Central Registry of Controlled Clinical Trials. Literatures were selected according to the predefined inclusion and exclusion criteria and the data were analyzed using meta analysis. Results Finally 20 references containing 21 studies were included in the present study. The overall analysis showed that a 1 mL/(min·1. 73 m2) GFR increment was associated with a 3. 3C increase in all-cause mortality (HR= 1. 033, 95 C CI: 1. 026-1. 040, p<0. 001). However, the subgroup analysis of two RCTs and four studies with the same survival analysis origin demonstrated no significant correlation between GFR at dialysis initiation and survival rate (HR=1. 001, 95CCI: 0. 983-1. 020, 3 = 0. 891* HR=1. 014, 95CCI: 0. 990-1. 040, 3 = 0. 260). In addition, subgroup analysis including studies with 10 or 10. 5 mL/(min·1. 73 m2) GFR as the cut-off values between early and late stages also showed no significant differences in the survival rates (HR= 1.062, 95CCI: 0. 691-1. 633, 3 = 0. 784). Conclusion It is indicated that higher GFR at dialysis initiation is associated with increasedmortality rate of CRF patients; however, the reason for early dialysis is complicated and more high quality clinical trials are needed to determine the dialysis timing.