Initiating chronic dialysis before the appearance of uremic symptoms or other clinical indication is associated with significant burden and inconvenience for the patient without any clinical benefit. Recent guidelines from the Canadian Society of Nephrology recommend that patients with an estimated glomerular filtration rate (eGFR) less than 15 mls/min should be closely followed by their Nephrologist and dialysis deferred until symptoms of uremia, volume overload, hyperkalemia or acidosis become an issue or the eGFR drops below 6 mls/min.

Conditions: Chronic Kidney Disease (CKD), Kidney Failure, Renal Failure, Uremia

Treatments: Chronic Dialysis, Hemodialysis, Peritoneal Dialysis

Sources

• Cooper BA, Branley P, Bulfone L, et al. A randomized, controlled trial of early versus late initiation of dialysis. N. Engl. J. Med. Aug 12 2010;363(7):609-619. (PubMed)
• Nesrallah GE, Mustafa RA, Clark WF, et al. Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis. CMAJ. Feb 4 2014;186(2):112-117. (PubMed)
• Susantitaphong P, Altamimi S, Ashkar M, et al. GFR at initiation of dialysis and mortality in CKD: a meta-analysis. Am. J. Kidney Dis. Jun 2012;59(6):829-840. (PubMed)