| Theme | Considering the timing of chronic dialysis (renal replacement therapy) initiation | |
|---|---|---|
| Title | Uremic symptom and dialysis initiation | |
| Publish Date | 2012/12 | |
| Author | Akihiko Kato | Blood Purification Unit, Division of Nephrology, Hamamatsu University School of Medicine |
| Author | Takayuki Tsuji | Internal Medicine 1, Division of Nephrology, Hamamatsu University School of Medicine |
| [ Summary ] | A recent prospective randomized trial demonstrated that early dialysis initiation based on estimated glomerular filtration rates (eGFR) does not result in better survival when compared to conventional late dialysis initiation. Therefore, there is renewed interest in the timing of dialysis initiation determined by uremic symptoms and/or preserving independence for daily life. In Japan, it has been reported that congestive heart failure, intractable edema and uremic neuropathy are all associated with long-term mortality in hemodialysis patients. Serum albumin levels lower than 4.0 g/dL at dialysis initiation also affect one-year prognoses. Additional studies are required to determine which uremic symptoms or nutritional markers of serum albumin are most useful in predicting long-term mortality after dialysis initiation. | |