title: At which stage of end-stage kidney disease should chronic dialysis be started?
abstract: The number of patients requiring renal replacement therapy has increased exponentially in recent years. However, there is still controversy regarding the best moment to initiate chronic dialysis. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified five systematic reviews comprising 21 trials addressing the question of this article. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded delaying the initiation of dialysis probably does not increase mortality risk in chronic kidney disease and makes little or no difference in the risk of requiring a temporary catheter or having to check the vascular access.
authors.affiliation: Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile. Address: Facultad de Medicina, Pontificia Universidad Católica de Chile, Lira 63, Santiago Centro, Chile. Email: madrid.trini@gmail.com.
authors.forename: Gonzalo A
authors.initials: GA
authors.lastname: Bravo-Soto
authors.affiliation: Proyecto Epistemonikos, Santiago, Chile; Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Trinidad
authors.initials: T
authors.lastname: Madrid
mesh_terms: D002404:Catheterization / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D006435:Renal Dialysis / Q000379:methods*; D017582:Renal Replacement Therapy / Q000379:methods; D013997:Time Factors