Dialysis Initiation: What's the Rush?. Issue 6 (19th September 2013)
- Record Type:
- Journal Article
- Title:
- Dialysis Initiation: What's the Rush?. Issue 6 (19th September 2013)
- Main Title:
- Dialysis Initiation: What's the Rush?
- Authors:
- Rosansky, Steven J.
Cancarini, Giovanni
Clark, William F.
Eggers, Paul
Germaine, Michael
Glassock, Richard
Goldfarb, David S.
Harris, David
Hwang, Shang‐Jyh
Imperial, Edwina Brown
Johansen, Kirsten L.
Kalantar‐Zadeh, Kamyar
Moist, Louise M.
Rayner, Brian
Steiner, Robert
Zuo, Li - Abstract:
- <abstract abstract-type="main" id="sdi12134-abs-0001"> <title>Abstract</title> <p>The recent trend to early initiation of dialysis (at eGFR &gt;10 ml/min/1.73 m<sup>2</sup>) 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<abstract abstract-type="main" id="sdi12134-abs-0001"> <title>Abstract</title> <p>The recent trend to early initiation of dialysis (at eGFR &gt;10 ml/min/1.73 m<sup>2</sup>) 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.</p> </abstract> … (more)
- Is Part Of:
- Seminars in dialysis. Volume 26:Issue 6(2013)
- Journal:
- Seminars in dialysis
- Issue:
- Volume 26:Issue 6(2013)
- Issue Display:
- Volume 26, Issue 6 (2013)
- Year:
- 2013
- Volume:
- 26
- Issue:
- 6
- Issue Sort Value:
- 2013-0026-0006-0000
- Page Start:
- 650
- Page End:
- 657
- Publication Date:
- 2013-09-19
- Subjects:
- Hemodialysis -- Periodicals
Dialysis -- Periodicals
Renal Dialysis -- Periodicals
617.461059 - Journal URLs:
- http://onlinelibrary.wiley.com/ ↗
- DOI:
- 10.1111/sdi.12134 ↗
- Languages:
- English
- ISSNs:
- 0894-0959
- Deposit Type:
- Legaldeposit
- View Content:
- Available online (eLD content is only available in our Reading Rooms) ↗
- Physical Locations:
- British Library DSC - 8239.448930
British Library DSC - BLDSS-3PM
British Library HMNTS - ELD Digital store - Ingest File:
- 3010.xml