When should you start kidney dialysis?

Over the past few years, evidence from some interesting studies have suggested the opportunity to start early dialysis treatment, in the natural history of the disease in reason of a possible improvement of survival and quality of life and a reduction in complications. 

In clinical practice, there are considerable differences in the timing of the start of kidney dialysis in patients in fifth stage of kidney disease. Traditionally, the treatment was started after the first appearance of signs and symptoms of uraemia.

By contrast, some studies have feared the possibility that the early start of the dialysis treatment may be dangerous. The study IDEAL (Initiating Dialysis Early and Late) addressed this important issue going to evaluate whether early start of dialysis treatment raise mortality in dialysis patients. In the study, 828 patients with progressive kidney disease assigned to dialysis treatment early (glomerular filtration rate between 10.0 and 15.0 ml / Minute 1,732 for body surface area) or late (glomerular filtration rate between 5.0 and 7.0 ml / minute). At the end of the follow-up period of 3:59 years, the mortality was not different in the two treatment groups (37.6% vs 36.6%). Similarly, cardiovascular events, infections and complications of dialysis did not differ in the two treatment groups. The question remains unsolved ...

Factors to consider when starting kidney dialysis

When starting dialysis in patients with renal disease "end stage" is a important clinical problem that has only recently been addressed in a randomized clinical trial of sufficient size, the IDEAL ( initiating Dialysis Early And Late).

 The main suggestions for clinical practice that emerge from this study are two:

• The uremic symptoms begin well before the filtrate is reduced to lower levels of 6 mL / min, and this phenomenon requires anticipation of the dialysis filtrate highest levels in the majority of patients.
• delay the onset of dialysis until the appearance of uremic symptoms approach is reasonably safe if you establish a good surveillance clinic.

The initiation of treatment should be considered when the filtrate is <15 mL / min in presence of uremic symptoms, failure to control the salt and water balance or in the presence of hypertension or a deterioration of nutritional status. The research on this important clinical problem is just beginning and the study IDEAL, has generated more questions than answers. In this issue of GIN Fran

From where to start?

 

• A periodic check of your doctor can help prevent the onset of disease symptoms or diagnose early presence. The final objective is still to slow the progression of the kidney disease and to delay as much as possible dialysis.
• If kidney disease is at an early stage it is possible to make the diagnosis of the type of kidney disease and begin a targeted treatment that may allow the recovery of renal function.
• If the cause of kidney failure is diabetes or hypertension, your doctor will tell you how to deal with and to better control the disease. The therapeutic measures are much more effective when they are taken early, before you have advanced kidney damage.
• Consider carefully what are your priorities in life: health should be one of them. Health should be put first even when you're at the table or you are doing your job. This is the first rule, especially for those already suffering from diabetes or hypertension, the two leading causes of kidney disease.