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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Dialysis Initiation: What's the Rush?
Seminars in Dialysis, Volume 26, No. 6, Year 2013
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Description
The recent trend to early initiation of dialysis (at eGFR >10 ml/min/1.73 m2) appears to have been based on conventional wisdoms that are not supported by evidence. Observational studies using administrative databases report worse comorbidity-adjusted dialysis survival with early dialysis initiation. Although some have concluded that the IDEAL randomized controlled trial of dialysis start provided evidence that patients become symptomatic with late dialysis start, there is no definitive support for this view. The potential harms of early start of dialysis, including the loss of residual renal function (RRF), have been well documented. The rate of RRF loss (renal function trajectory) is an important consideration for the timing of the dialysis initiation decision. Patients with low glomerular filtration rate (GFR) may have sufficient RRF to be maintained off dialysis for years. Delay of dialysis start until a working arterio-venous access is in place seems prudent in light of the lack of harm and possible benefit of late dialysis initiation. Prescribing frequent hemodialysis is not recommended when dialysis is initiated early. The benefits of early initiation of chronic dialysis after episodes of congestive heart failure or acute kidney injury require further study. There are no data to show that early start benefits diabetics or other patient groups. Preemptive start of dialysis in noncompliant patients may be necessary to avoid complications. The decision to initiate dialysis requires informed patient consent and a joint decision by the patient and dialysis provider. Possible talking points for obtaining informed consent are provided. © 2013 Wiley Periodicals, Inc.
Authors & Co-Authors
Rosansky, Steven
Unknown Affiliation
Cancarini, Giovanni
Unknown Affiliation
Clark, William F.
Unknown Affiliation
Eggers, Paul
Unknown Affiliation
Germaine, Michael
Unknown Affiliation
Glassock, Richard
Unknown Affiliation
Goldfarb, David A.
Unknown Affiliation
Harris, David C.H.
Unknown Affiliation
Hwang, Shang Jyh
Unknown Affiliation
Imperial, Edwina Brown
Unknown Affiliation
Johansen, Kirsten L.
Unknown Affiliation
Kalantar-Zadeh, Kamyar
Unknown Affiliation
Moist, Louise M.
Unknown Affiliation
Rayner, Brian L.
Unknown Affiliation
Steiner, Robert
Unknown Affiliation
Zuo, Li
Unknown Affiliation
Statistics
Citations: 52
Authors: 16
Affiliations: 17
Identifiers
Doi:
10.1111/sdi.12134
ISSN:
08940959
e-ISSN:
1525139X
Research Areas
Health System And Policy
Noncommunicable Diseases
Violence And Injury
Study Approach
Quantitative