[Indications for starting kidney replacement therapy].
In view of the lack of scientific evidence to support the initiation of KRT from a specific filtration rate, certain conclusions can be drawn whose application in clinical practice may be useful. The recommendations we could make are: - Scheduled initiation of KRT is associated with a better patient prognosis (Strength of Recommendation B). - KRT should be planned in advance so that the patient can freely choose the technique for KRT (Strength of Recommendation B). - If the patient starts HD with a permanent vascular access, his/her course will be better (Strength of Recommendation B). - When the patient has any clinical indication for initiating KRT, this should not be postponed (Strength of Recommendation A). - Glomerular filtration rate is the best way to assess kidney function (Strength of Recommendation B). - Patients with a glomerular filtration rate less than 15 ml/min and any symptom associated with uremia not correctable by conventional treatment should be assessed for the initiation of KRT (Strength of Recommendation C). - Patients with a glomerular filtration rate less than 6-8 ml/min should initiate KRT even if they are minimally symptomatic (Strength of Recommendation C). - Patients with more comorbidities or more extreme ages (children, elderly, diabetics, heart disease patients,...) could benefit from the initiation of KRT before other types of patients (Strength of Recommendation C). - Some patients with associated comorbid conditions could even benefit from the initiation of KRT with glomerular filtration rates above 15 ml/min (Strength of Recommendation C).
Tornero Molina
F
F
Hospital Virgen de la Luz, Cuenca.
Remón Rodríguez
C
C
D002908:Chronic Disease; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000592:standards*