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has not received a clear-cut response during the past References two decades. 1. Hakim RM, Lazarus JM. Initiation of dialysis. J Am Soc Nephrol 1995; 6: 1319–1328 Persisting dilemmas 2. Burkart JM. Clinical experience: how much earlier should patients really start renal replacement therapy? J Am Soc Nephrol 1998; 9 [Suppl ]: S118–S123 Deferred versus early initiation of dialysis thus cur3. Walser M, Hill S. Can renal replacement be deferred by a rently remains a matter of controversy, dividing the supplemented very low-protein diet? J Am Soc Nephrol 1999; nephrological community into believers and skeptics, [10]: 110–116 and even opponents, of either concept. The presence 4. Rahn KH, Heidenreich S, Bruckner D. How to assess glomerular function and damage in humans. J Hypertens 1999; 17: 309–317 of significant comorbidities has to be carefully consid5. Chertow GM, Lazarus JM, Lew NL, Ma L, Lowrie EG. ered in making the decision of an appropriate time for Development of a population-specific regression equation to starting dialysis. The nephrologist should also not be estimate total body water in hemodialysis patients. Kidney Int too favourably influenced for delaying the initiation of 1997; 51: 1578–1582 dialysis by the improvement of the clinical status 6. NKF–DOQI. Clinical practice guidelines for initiation of perialleged by patients whose anaemia is efficiently cortoneal dialysis. Am J Kidney Dis 1997; 30 [Suppl 2]: S70–S73 7. Bonomini V, Feletti C, Scolari MP, Stefoni S. Benefits of early rected by Rh-Epo therapy. initiation of dialysis. Kidney Int 1985; 28 [Suppl 17]: S57–S59 From a practical point of view, it can be reasonably 8. Locatelli F, Andrulli S, Pontoriero G, Di Filippo S, Bigi MC. stated that timely initiation of dialysis treatment cannot Supplemented low-protein diet and once-weekly hemodialysis. be based merely on numerical data, but should be Am J Kidney Dis 1994; 24: 192–204 decided according to the overall clinical tolerance of 9. Tattersall J, Greenwood R, Farrington K. Urea kinetics and each individual patient to his or her advanced stage of when to commence dialysis. Am J Nephrol 1995; 15: 283–289 10. Golper Th A. Incremental dialysis. J Am Soc Nephrol 1998; 9 uraemia, the most important parameters to be consid[Suppl ]: S107–S111 ered being; adequate control of blood pressure and 11. Keshaviah PR, Emerson PF, Nolph KD. Timely initiation of quality of nutritional status. Initiating dialysis at the dialysis. A urea kinetic approach. Am J Kidney Dis 1999: right time for a given patient with the most appropriate 33; 344–348 technique represents a sophisticated exercise of clinical 12. Locatelli F, Del Vecchio L. How long can dialysis be postponed medicine, which remains, and will remain a balanced by low protein diet and ACE inhibitors? Nephrol Dial Transplant 1999; 14: 1360–364 mixture of Science and Art.

Comparison of survival on CAPD and haemodialysis: statistical pitfalls