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

Preka, Evgenia; Rees, Lesley

doi:10.1007/s00467-019-04333-4

Cited by 10 publications

(15 citation statements)

References 52 publications

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“…2 While these studies are registry reports only and must be interpreted with caution, the accuracy of eGFR estimation in late stages of CKD must also be interpreted with caution. 3 The Schwartz bedside formula, which can be used to estimate GFR in children, was developed in the CKD in children study and is most valid in the GFR range of 15-75 ml/min/1.73 m 2 and with the use of standardized serum creatinine methods traceable to the isotope dilution mass spectrometry technique. 2 In the setting when a creatininebased estimate may be inaccurate (e.g.…”

Section: Level Of Evidence-grade 2dmentioning

confidence: 99%

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Prescribing peritoneal dialysis for high-quality care in children

et al. 2020

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Background: Peritoneal dialysis (PD) remains the most widely used modality for chronic dialysis in children, particularly in younger children and in lower and middle income countries (LMICs). We present guidelines for dialysis initiation, modality selection, small solute clearance, and fluid removal in children on PD. A review of the literature and key studies that support these statements are presented. Methods: An extensive Medline search for all publications on PD in children was performed using predefined search criteria. Results: High-quality randomized trials in children are scarce and current clinical practice largely relies on data extrapolated from adult studies or drawn from observational cohort studies in children. The evidence and strength of the recommendation is GRADE-ed, but in the absence of high-quality evidence, the opinion of the authors is provided and must be carefully considered by the treating physician, and adapted to local expertise and individual patient needs as appropriate. We discuss the timing of dialysis initiation, factors to be considered when selecting a dialysis modality, the assessment and management of volume status on PD, achieving optimal small solute clearance, and the importance of preserving residual kidney function. While optimal dialysis must remain the goal for every patient, a careful discussion with fully informed patients and caregivers is important to understand the patient and family’s expectations of dialysis and reasonable adjustments to the dialysis program may be considered in accordance with a philosophy of shared decision-making. Conclusions: There continues to be very poor evidence in the field of chronic PD in children and these recommendations can at best serve to guide clinical decision-making. In LMICs, every effort should be made to conform to the framework of these statements, taking into account resource limitations.

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Section: Level Of Evidence-grade 2dmentioning

confidence: 99%

“…2 While these studies are registry reports only and must be interpreted with caution, the accuracy of eGFR estimation in late stages of CKD must also be interpreted with caution. 3…”

Section: Dialysis Initiationmentioning

confidence: 99%

Prescribing peritoneal dialysis for high-quality care in children

et al. 2020

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“…Recently, the European Society of Paediatric Nephrology/ European Renal Association and European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry 5 examined the same question in 2963 patients from 21 European countries using a eGFR cutoff value of 8 ml/min per 1.73 m 2 (representing more accurately the current practice worldwide and following clinical practice guidelines as per Kidney Disease Outcomes Quality Initiative 2015, National Institute for Health and Care Excellence 2018, and Kidney Disease Improving Global Outcomes 2019). 3 There was no difference in terms of morbidity, mortality, growth, and access to transplantation, except a higher risk of developing hypertension among late starters (64% versus 51% among early starters). However, it is important to mention that the International Pediatric Peritoneal Dialysis Network found in 1001 children and adolescents on peritoneal dialysis that late dialysis start was associated with underweight (11% and 5% in children starting peritoneal dialysis at an eGFR of ,6 ml/min per 1.73 m 2 and an eGFR of 9-12 ml/min per 1.73 m 2 , respectively), which may favor early start in that setting.…”

Section: Think Twice Before Postponing Chronic Dialysis In Childrenmentioning

confidence: 84%

“…However, the current median eGFR at dialysis initiation is 7.8, 8.1, and 8.2 ml/min per 1.73 m 2 in the United States, Canada, and Europe, respectively (all below the cutoff limit of 10 ml/min per 1.73 m 2 ). 3 The only published randomized controlled trial (RCT) studying the effect of initiating dialysis early (10-15 ml/min per 1.73 m 2 ) versus late (5-7 ml/min per 1.73 m 2 ) 4 in adults revealed no differences in all-cause mortality, economics, or quality of life. Although the results of this RCT could not be entirely generalizable to children, we could conclude that, among patients with asymptomatic ESKD, initiation of dialysis can be safely postponed.…”

Section: Think Twice Before Postponing Chronic Dialysis In Childrenmentioning

confidence: 99%

Think Twice before Postponing Chronic Dialysis in Children

Preka

Bonthuis

Harambat³

et al. 2019

JASN

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“…Healthcare providers commonly rely on quantitative laboratory, imaging, or histopathological measures of kidney health to assess disease progression and determine treatment options. However, trial data in adults suggests that important decisions, such as timing of dialysis initiation, should be guided by symptom severity rather than laboratory testing (e.g., estimated glomerular filtration rate (eGFR)) alone [6,7].…”

Section: Introductionmentioning

confidence: 99%