The optimal timing of initiation of maintenance dialysis in patients with end stage renal disease (ESRD) is not currently known. 1 Recent clinical trial results have challenged the established paradigm of using estimates of glomerular filtration as the primary guide for initiation of maintenance dialysis. 2 Even though clinical practice guidelines recommend using symptom burden to guide the decision to start dialysis, no published study has reported on the longitudinal changes in symptom burden and physical performance of community-dwelling adults with chronic kidney disease (CKD) through the transition to ESRD. 3–5 Such data are critical to adequately inform clinical decision making as it is presently not known which symptoms or physical performance measures might consistently improve with initiation of dialysis. In this study, we investigated changes in symptom burden and measures of physical performance before and after the initiation of chronic dialysis.

Participants were identified from the Seattle Kidney Study (SKS), a clinic-based prospective cohort study of CKD based in Seattle, WA. 6 Annually during follow-up, study participants were administered the Kidney Disease Quality of Life (KDQOL) questionnaire, a self-report measure of health status that includes a generic core (SF-36) combined with number of multi-item scales targeted at areas of concern for patients with kidney disease. 7 Physical performance data including the Short Physical Performance Battery (SPPB), timed-get-upandgo, 6 minute walk distance, and lung spirometry were also collected annually. Of the 682