title: 'Ideal criteria' for starting chronic hemodialysis: numbers, symptoms or an alerting 'traffic light' system?
abstract: A definite criteria for starting chronic hemodialysis treatment is still lacking even after 50 years of regular hemodialysis treatment. Although none of the current guidelines have designated a certain glomerular filtration rate (GFR) level to start hemodialysis, most favor an 'earlier' start after GFR falls below 15 ml/min. Hence, since mid-1990s, more patients have initiated dialysis on higher GFR levels. Most of the observational data and one randomized trial, however, failed to find any benefit, but even harm, from an earlier start in various patient populations including the healthiest groups. This paper has reviewed the available evidence and criticized the use of only 'GFR level' in the absence of a validated method in end-stage kidney disease patients. A new patient scoring system mimicking traffic lights was proposed in which patients were placed into green, yellow or red zones for deciding the ideal time to start hemodialysis. This scoring system should include not only validated GFR criteria but also a wide set of demographic and clinical parameters.
authors.affiliation: Unit of Nephrology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey. marici@hacettepe.edu.tr
authors.forename: Mustafa
authors.initials: M
authors.lastname: Arici
mesh_terms: D002986:Clinical Trials as Topic; D003657:Decision Making; D014943:Global Health; D005919:Glomerular Filtration Rate; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D015337:Multicenter Studies as Topic; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000009:adverse effects / Q000706:statistics & numerical data; D013997:Time Factors