When to start dialysis treatment: where do we stand?
BACKGROUND
Since the publication of opinion-based guidelines regarding the timing of dialysis treatment, there has been a trend toward earlier initiation.


OBJECTIVE
In this review, the existing guidelines and the currently published studies that evaluate them are discussed.


RESULTS
These studies could not demonstrate a clear benefit on survival or quality of life for patients who started with relatively higher renal function.


CONCLUSIONS
Early start of dialysis treatment should not be confused with early referral to the nephrologist. It is concluded that initiation of dialysis should not depend on a predefined magnitude of renal function, but should be tailored to the individual patient.
Korevaar
Johanna C
JC
Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands. j.korevaar@amc.uva.nl
van Manen
Jeannette G
JG
Boeschoten
Elisabeth W
EW
Dekker
Friedo W
FW
Krediet
Raymond T
RT
D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D011788:Quality of Life; D006435:Renal Dialysis; D016019:Survival Analysis; D013997:Time Factors