[When and for whom to start dialytic therapy?].

Area of Science:

• Nephrology
• Internal Medicine

Context:

• Increasing prevalence of multiple comorbidities in patients requiring renal replacement therapy.
• Acute indications include refractory hyperkalemia, acidosis, fluid overload, and uremic symptoms.
• Chronic kidney disease treatment initiation typically occurs at an estimated glomerular filtration rate (eGFR) of 5-10 mL/min/1.73m² with symptomatic renal insufficiency.

Purpose:

• To outline the indications and considerations for initiating dialytic therapy in patients with kidney disease.
• To highlight the balance between therapeutic benefits and quality of life impairments associated with dialysis.

Summary:

• Dialytic therapy is a crucial intervention for acute and chronic kidney conditions, addressing critical symptoms like hyperkalemia, acidosis, and fluid overload.
• Initiation for chronic kidney insufficiency is generally recommended at an eGFR of 5-10 mL/min/1.73m² when symptoms arise.
• The decision to start dialysis requires careful consideration of its limited symptomatic improvement versus significant impacts on patient quality of life and potential complications.

Impact:

• Informs clinical decision-making regarding the initiation and appropriateness of dialytic therapies.
• Emphasizes the need for a comprehensive patient assessment beyond mere eGFR values.
• Highlights the trade-offs between life-sustaining treatment and patient well-being in advanced kidney disease.