title: The right patient, the right treatment, the right access and the right time.
abstract: As the incidence of CKD increases, so will the ESRD population. Pre-ESRD care, including early referral to nephrology and patient education, enables patients and providers working together to determine which therapy modality is best suited for their individualized needs: conservative therapy, kidney transplant, hemodialysis, or peritoneal dialysis. Differentiating the therapy modality should be based on many factors and not solely based on outcome data. Acknowledging that there is no "one-size-fits-all" therapy modality allows the patient and the interdisciplinary team to ensure that the appropriate access is chosen at the appropriate time. Lastly, the timing of initiation is paramount for improving patient outcomes, including less central venous catheter placement in incident hemodialysis and more planned arteriovenous accesses, improved quality of life, less hospitalization time, and reduced costs.
authors: Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: Denise.Link@utsw.edu.
authors: Denise Keller
authors: DK
authors: Link
authors: Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Ramesh
authors: R
authors: Saxena
mesh_terms: D001166:Arteriovenous Shunt, Surgical; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling; D018450:Disease Progression; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation / Q000379:methods*; D010353:Patient Education as Topic; D018579:Patient Selection; D011788:Quality of Life; D012017:Referral and Consultation; D006435:Renal Dialysis / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000628:therapy; D061665:Time-to-Treatment
keywords: Hemodialysis; Kidney education; Peritoneal dialysis; Renal replacement therapy; Timing of dialysis initiation