Related Experiment Video

Updated: Jan 20, 2026

A Networked Desktop Virtual Reality Setup for Decision Science and Navigation Experiments with Multiple Participants
06:28

A Networked Desktop Virtual Reality Setup for Decision Science and Navigation Experiments with Multiple Participants

Published on: August 26, 2018

6.3K

Should we abandon GFR in the decision to initiate chronic dialysis?

Evgenia Preka1, Lesley Rees2

  • 1Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS foundation Trust, Great Ormond Street, London, WC1N 3JH, UK. evgenia.preka@gmail.com.

Pediatric Nephrology (Berlin, Germany)
|August 17, 2019
PubMed

Insights

Starting chronic dialysis earlier in stage 5 chronic kidney disease (CKD) offers no survival benefit. Evidence from adult and pediatric studies suggests delaying dialysis initiation is appropriate for most patients with advanced CKD.

Area of Science:

  • Nephrology
  • Clinical Trials
  • Renal Medicine

Background:

  • The optimal timing for initiating chronic dialysis in patients with stage 5 chronic kidney disease (CKD) remains a subject of debate.
  • Recent evidence from a major randomized controlled trial in adults and analyses of large pediatric registries offers new insights.

Purpose of the Study:

  • To review the evidence regarding the timing of dialysis initiation in advanced CKD.
  • To discuss the limitations of current studies and factors influencing the decision-making process for early versus late dialysis start.

Main Methods:

  • Review of the IDEAL study (a randomized trial in adults).
  • Analysis of data from the U.S. Renal Data System (USRDS) and European Society of Paediatric Nephrology (ESPN) Registry.
  • Discussion of study limitations and assessment factors.

Main Results:

  • Consensus across four major studies indicates no survival advantage from initiating dialysis early in stage 5 CKD.
  • The findings apply to both adult and pediatric populations.

Conclusions:

  • The current evidence suggests that initiating dialysis later in the course of stage 5 CKD is not associated with harm and may be preferable.
  • Further discussion is needed regarding the assessment of glomerular filtration rate (GFR) at later CKD stages and the specific factors that determine the benefits of early versus late dialysis initiation.

Keywords:
End-stage kidney diseaseGFRRenal replacement therapyTiming of dialysis initiation

More Related Videos

Surgical Techniques for Catheter Placement and 5/6 Nephrectomy in Murine Models of Peritoneal Dialysis07:11

Surgical Techniques for Catheter Placement and 5/6 Nephrectomy in Murine Models of Peritoneal Dialysis

Published on: July 19, 2018

16.0K
Combining Behavioral Endocrinology and Experimental Economics: Testosterone and Social Decision Making11:51

Combining Behavioral Endocrinology and Experimental Economics: Testosterone and Social Decision Making

Published on: March 2, 2011

15.6K

Related Concept Videos

Dialysis01:15

Dialysis

Dialysis is a diffusion-based purification process that separates analyte molecules from a complex matrix. This is accomplished by allowing molecules in the solution to pass through a semipermeable membrane into a liquid on the other side. The membrane is usually made of cellulose acetate or cellulose nitrate, and the second liquid must be miscible with the solution. Ions (e.g., chloride or sodium) or organic molecules (e.g., glucose) can pass through the membrane pores, which generally have...
1.7K
Dialysis01:27

Dialysis

Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
1.2K
Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications01:25

Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications

Peritoneal dialysis (PD) is a medical process that removes waste products and excess fluid from the body using the peritoneal membrane as a natural filter.Peritoneal Dialysis MethodsSeveral methods can be used for peritoneal dialysis, including Acute Intermittent Peritoneal Dialysis, Continuous Ambulatory Peritoneal Dialysis, and Automated Peritoneal Dialysis, also known as Continuous Cyclic Peritoneal Dialysis.Acute Intermittent Peritoneal Dialysis (AIPD) is used for patients with uremic...
590
Initiation of Translation02:33

Initiation of Translation

Initiating translation is complex because it involves multiple molecules. Initiator tRNA, ribosomal subunits, and eukaryotic initiation factors (eIFs) are all required to assemble on the initiation codon of mRNA. This process consists of several steps that are mediated by different eIFs.
First, the initiator tRNA must be selected from the pool of elongator tRNAs by eukaryotic initiation factor 2 (eIF2). The initiator tRNA (Met-tRNAi) has conserved sequence elements including modified bases at...
38.4K
Initiation of Translation02:33

Initiation of Translation

7.9K
Peritoneal Dialysis I: Introduction and Procedure01:30

Peritoneal Dialysis I: Introduction and Procedure

Peritoneal dialysis (PD) is a procedure that facilitates the exchange of solutes, waste products, electrolytes, and excess fluid between the blood in the peritoneal capillaries and a dialysis solution introduced into the peritoneal cavity.Principles of Peritoneal Dialysis (PD)Diffusion: Waste products such as urea and electrolytes move from high concentrations in the blood to low concentrations in the dialysate across the peritoneal membrane. This mechanism is driven by the concentration...
2.6K