title: Starting dialysis is dangerous: how do we balance the risk?
abstract: Recent studies of timing of dialysis initiation have challenged the recent trend to earlier initiation of therapy. The observed outcomes though are a consequence of the balance between the risks of advanced uremia versus the inherent dangers relating to dialysis therapy itself. Many of these risks are inherent in how dialysis treatment is currently carried out, and may indeed be amenable to mitigation, through refinement of clinical practice (and potentially modality choice). This article aims to lay out a discussion relating to patient outcomes being the composite result of this balance, pivoting on the vulnerability of a particular patient to these attendant risks.
authors.affiliation: Department of Vascular Medicine, School of Graduate Entry Medicine and Health, University of Nottingham, Nottingham, UK. Chris.Mcintyre@nottingham.ac.uk
authors.forename: Christopher W
authors.initials: CW
authors.lastname: McIntyre
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Rosansky
mesh_terms: D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D061214:Patient Safety; D018579:Patient Selection; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014511:Uremia / Q000209:etiology / Q000628:therapy