Early Dialysis and Renal Transplantation

Bonomini, V.; Feletti, C; Stefoni, Sergio; Vangelista, A

doi:10.1159/000184004

Cited by 32 publications

(17 citation statements)

References 6 publications

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“…10,11 This trend has, in part, been explained by observational evidence suggesting improved outcomes with earlier dialysis initiation. 12,13 However, the trend of earlier dialysis initiation parallels the utilization of automated eGFR reporting. For example, only 33% of patients in the United States started dialysis with an eGFR .10 ml/min per 1.73 m 2 in 2000, whereas .50% of patients started dialysis with an eGFR .10 ml/min per 1.73 m 2 in 2009, the period when eGFR reporting became widespread.…”

Section: Discussionmentioning

confidence: 99%

Estimated GFR Reporting Influences Recommendations for Dialysis Initiation

Brimble

Mehrotra

Hawley

et al. 2013

Journal of the American Society of Nephrology

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Automated reporting of estimated GFR (eGFR) with serum creatinine measurement is now common. We surveyed nephrologists in four countries to determine whether eGFR reporting influences nephrologists' recommendations for dialysis initiation. Respondents were randomly allocated to receive a survey of four clinical vignettes that included either serum creatinine concentration only or serum creatinine and the corresponding eGFR. For each scenario, the respondent was asked to rank his or her likelihood of recommending dialysis initiation on a modified 8-point Likert scale, ranging from 1 ("definitely not") to 8 ("definitely would"). Analysis of the 822 eligible responses received showed that the predicted likelihood of recommending dialysis increased by 0.55 points when eGFR was reported (95% confidence interval, 0.33 to 0.76), and this effect was larger for eGFRs .5 ml/min per 1.73 m 2 (P,0.001). Subgroup analyses suggested that physicians who had been in practice $13 years were more affected by eGFR reporting (P=0.03). These results indicate that eGFR reporting modestly increases the likelihood that dialysis is recommended, and physicians should be aware of this effect when assessing patients with severe CKD.

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Section: Discussionmentioning

confidence: 99%

Estimated GFR Reporting Influences Recommendations for Dialysis Initiation

Brimble

Mehrotra

Hawley

et al. 2013

Journal of the American Society of Nephrology

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“…Some of these studies and cases supported an early initiation of dialysis in order to improve the survival rate of the patient, the quality of life and to diminish the uraemia complications (16, 17), while others suggest that an early initiation is not associated with clear survival advantages and could actually be deleterious to patient’s health (18-24). Patients who starting dialysis at higher levels of GFR in fact seem to have an increased risk of death not fully explained by the concomitant presence of associated pathologies (25).…”

Section: Timing Of Dialysis Initiationmentioning

confidence: 99%

When Should Commence Dialysis: Focusing on the Predialysis Condition

Maffei¹,

Savoldi

Triolo³

2013

Nephro Urol Mon

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The prevalence of chronic kidney disease (CKD), as defined by the NFK-KDOQI (the national kidney foundation kidney disease outcomes quality initiative) guidelines, is a glomerular filtration rate less than 60 mL/min/1.73 m2 or the presence of microalbuminuria. CKD is increasing worldwide, leading to an increased risk of cardiovascular disease. There is general agreement on the importance of an early referral to a nephrologist and predialysis educational programs. Establishing the protocol for an early approach may assist in preventing the progression, and the most common complications of renal disease.Predialysis education helps patients in order to choose a renal replacement therapy (hemodialysis, peritoneal dialysis, transplantation) and improve their quality of life. Furthermore, adequate predialysis care allows the nephrologist to promptly prepare for vascular or peritoneal treatment. Regrettably, patients are often referred to the nephrologist when renal failure is already fall in the advanced stage. This is caused primarily by non-nephrologists failing to identify patients at risk for imminent renal failure. Furthermore, they may be defining the patient’s degree of renal failure according to the KDOQI classification. To further complicate matters, the serum creatinine alone does not provide an adequate estimate of renal function; however, both the MDRD (the modification of diet in renal disease) equation and the Cockcroft-Gault formula permit the more reliable and accurate estimation of the all-important glomerular filtration rate (GFR). Using the MDRD equation, the KDOQI guidelines recommend referral when GFR is less than 30 mL/min/1.73 m2. Late nephrology referral is an independent risk factor for early death while on dialysis; it is also associated with a more frequent use of temporary catheters, particularly in the elderly individuals. This subject underlines the importance of a multidisciplinary predialysis approach that may bring additional benefits – beyond referral to a nephrologist – including a reduced hospitalization period and a lower mortality rate.The KDOQI guidelines recommend evaluating the benefits and risks of starting renal replacement therapy when patients reach stage 5 (estimated GFR less than 15 mL/min/1.73 m2), although the ideal period for initiation of the replacement therapy remained a source of debate.

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“…Waiting for some of these clinical events may well place the patient in jeopardy. This concern, in addition to a number of cohort studies,1 2 lead to the opinion-based guidelines to initiate chronic dialysis at a predefined, ‘early’ level, based on calculated glomerular filtration rate (GFR) 3. The consequence of these recommendations resulted in a doubling, between 1996 and 2005, of patients started on chronic dialysis with an estimated GFR >10 ml/min.…”

Section: Contextmentioning

confidence: 99%

Early initiation of dialysis in patients with chronic progressive kidney failure does not confer a mortality advantage when compared with an approach of late initiation combined with appearance of symptoms or signs of uraemia

Spinowitz

2010

Evid Based Med

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Early Dialysis and Renal Transplantation

Cited by 32 publications

References 6 publications

Estimated GFR Reporting Influences Recommendations for Dialysis Initiation

Estimated GFR Reporting Influences Recommendations for Dialysis Initiation

When Should Commence Dialysis: Focusing on the Predialysis Condition

Early initiation of dialysis in patients with chronic progressive kidney failure does not confer a mortality advantage when compared with an approach of late initiation combined with appearance of symptoms or signs of uraemia

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