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논문분류	춘계학술대회 초록집
제목	Trends and Practices in Early versus Late Initiation of Renal Replacement Therapy in South Korea and Taiwan
저자	Soie Kwon
출판정보	2024; 2024(1):
키워드
초록	Objectives: Identifying the optimal timing for Renal Replacement Therapy (RRT) initiation is challenging due to various clinical factors. This leads to significant variability in initiation times among nephrologists, which may vary by country and era. Our study compares RRT initiation practices in South Korea and Taiwan, focusing on changes in the estimated Glomerular Filtration Rate (eGFR) from 2000 to 2022. Methods: A retrospective cohort study in two teritiary South Korean hospitals and one teritiary Taiwanese hospital was performed. The lowest eGFR within this period defined the initiation point. RRT modalities included hemodialysis, peritoneal dialysis, and kidney transplantation. Results: Among 9,023 patients, 8,244 (91.5%) started RRT with an eGFR <15 mL/min/1.73m^2, and 464 (5.2%) patients initiated RRT with an eGFR between 15 and 30. The majority of patients in Taiwan (99.8%) initiated RRT with an eGFR <15, while in Korea, a portion of patients (4.4%) started RRT with an eGFR of 30 or higher (Table 1). Patients who started dialysis with an eGFR of 30 or higher were excluded from further analysis (N=8,708). The median eGFR at the initiated RRT point was low in Taiwan 3.9 [3.1‒5.0] than in Korea 7.5 [IQR 5.4‒10.5] (p-value <0.001). In Korea, the eGFR at the start of RRT gradually increased from 7.3 [4.7; 12.0] in 2000-2004 to 8.1 [5.8; 10.5] in 2020-2022 (p-for-trend <0.001). In contrast, in Taiwan, there was no significant change, with eGFR starting points moving from 4.0 [3.1; 5.2] in 2005-2009 to 4.1 [3.2; 5.1] in 2020-2022 (p-for-trend 0.919). Conclusions: The study reveals a lower eGFR threshold for dialysis initiation in Taiwan compared to South Korea, with trends indicating an earlier RRT initiation in Korean patients in recent years. Future research will explore whether these differences in eGFR thresholds affect outcomes like mortality.
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