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Fliss E. M. Murtagh, James E. Marsh, Paul Donohoe, Nasirul J. Ekbal, Fiona E. Harris, Neil S. Sheerin, Reply, Nephrology Dialysis Transplantation, Volume 23, Issue 5, May 2008, Page 1769, https://doi.org/10.1093/ndt/gfm882
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Sir,
We agree that the result may vary according to the type of analysis that is performed. However, we chose the intention-to-treat type of analysis to best inform nephrologists and patients at the time when decisions on future treatment are being made. We feel that there is very little data available to help this process. Changing to an as-treated analysis would be less useful for this purpose. Performing the as-treated analysis would focus on the effect of dialytic treatment, which was not the primary purpose of the study. Using an as-treated analysis, where the start point of the study is at eGFR of 15 mL/min, could be flawed, as those patients needing dialysis would generally have survived longer.
Patients who choose dialysis do have a better survival. We are not claiming that this is necessarily due to dialysis treatment. Indeed, as Misra et al . point out, patients who chose dialysis may not have started treatment, either because of death or not requiring dialysis in the study period. We therefore speculate that many factors affect the decision to choose dialysis, including patient's wishes and advice from physicians. These factors are not readily identified from the medical records. However, the result is that the two groups of patients identified at the time of the dialysis decision have different survival, some of this difference possibly being attributable to dialysis.
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