People who started dialysis early, based on their kidney function, were more likely to die in the first year than were those who started dialysis at a later stage of their disease: about 20 percent vs. 7 percent, the study found.

In addition, those with the lowest levels of albumin -- a protein made by the liver --also were at an increased risk for dying in the first year, compared with those with the highest albumin levels (21 percent vs. 5 percent), the researchers noted.

Other factors linked to an increased mortality risk were increasing age, being black or male and having a lower body mass index.

Having higher levels of hemoglobin, being treated at a later stage, being Asian and having certain types of kidney disease were linked with better survival, the study found.

Rosansky said that other studies have also found no benefit to early dialysis.

"The bodies of physicians that write guidelines need to reexamine their recommendations for putting people on dialysis at higher and higher levels of kidney function since there is no benefit seen in any studies," he said.

Dr. Kirsten L. Johansen, a nephrology professor at the University of California, San Francisco, and the San Francisco VA Medical Center, who wrote an editorial that accompanied publication of the study, said that "we don't have a lot of data to show that it is beneficial to start dialysis earlier, and it may be harmful."

Starting dialysis is a judgment call, Johansen said. "But, over the years we have been doing it earlier and earlier," she said. "We really need to step back and say that the question shouldn't be, 'Does the patient have symptoms of kidney disease?' but 'Does this patient have enough symptoms that they'd be better off on dialysis?' "

Years ago, doctors tried to keep people off dialysis as long as possible, Johansen said. Now, she said, the pendulum had swung too far in the other
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