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When to start dialysis treatment: where do we stand?
Johanna C Korevaar1, Jeannette G van Manen, Elisabeth W Boeschoten
1Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands. j.korevaar@amc.uva.nl
Summary
Starting dialysis early does not improve survival or quality of life. Decisions about initiating dialysis should be individualized, not based on a set level of kidney function.
Area of Science:
- Nephrology
- Renal Medicine
- Dialysis Therapy
Background:
- A trend towards earlier initiation of dialysis treatment has emerged following opinion-based guidelines.
- This shift contrasts with previous approaches to determining dialysis timing.
Purpose of the Study:
- To review existing guidelines on dialysis initiation timing.
- To evaluate published studies assessing the impact of these guidelines.
Main Methods:
- Review of current clinical guidelines for dialysis initiation.
- Analysis of scientific literature evaluating early versus late dialysis initiation.
Main Results:
- Studies reviewed did not show a significant survival benefit for patients starting dialysis earlier.
- No clear improvement in quality of life was observed for patients initiating dialysis with higher residual renal function.
Conclusions:
- Early dialysis initiation should not be equated with early nephrology referral.
- Dialysis initiation decisions require personalized assessment rather than reliance on predefined renal function thresholds.