[End-stage renal disease: what is established?]

End-stage renal disease represents the terminal stage of chronic kidney disease and is characterized by a persistently reduced glomerular filtration rate of < 15 mL/min per 1.73 m². In Germany, approximately 80,000 patients receive maintenance dialysis. The majority undergo in-center hemodialysis. At present, no specific glomerular filtration rate threshold can be recommended for the initiation of kidney replacement therapy. The decision to commence treatment should instead be based on the persistence of clinical symptoms and laboratory abnormalities that are refractory to appropriate conservative management. Available kidney replacement modalities include hemodialysis, peritoneal dialysis, and kidney transplantation. The choice of dialysis modality should be individualized and take into account medical eligibility, comorbidities, the patient's social and living circumstances, and individual preferences. Comprehensive counseling should include information on home-based dialysis modalities. In addition to optimizing dialysis treatment, rigorous management of comorbidities and cardiovascular risk factors is essential. Early and structured assessment for kidney transplantation should be considered in all potentially eligible patients.