| Theme | Considering the timing of chronic dialysis (renal replacement therapy) initiation | |
|---|---|---|
| Title | Timely PD initiation for patients with end stage kidney disease | |
| Publish Date | 2012/12 | |
| Author | Yoshimitsu Hayashi | Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine |
| Author | Hiroshi Kimura | Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine |
| Author | Hiroyuki Terawaki | Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine |
| Author | Masaaki Nakayama | Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine |
| [ Summary ] | In 2006, the National Kidney Foundation updated the guidelines which specify physician should consider the benefits, risks, and disadvantages of renal-replacement therapy when the estimated GFR (eGFR) is less than 15.0 mL/min/1.73 m2. In 2009, the Japan Dialysis Committee recommended that peritoneal dialysis should be started at least by the time of eGFR levels reach 6 mL/min/1.73 m2. Controversy exists as to whether early initiation of dialysis for patients with stage V CKD provides benefits as opposed to late initiation. Some retrospective studies have shown early initiation of patients provides poor prognoses, compared to late initiation. However, in 2010, a randomized, controlled trial (IDEAL study) revealed no clinical benefit were observed in the early initiation group (eGFR 10-15 mL/min/1.73 m2) as compared to the late initiation group (5-7 mL/min/1.73 m2). Some patients in each group began dialysis incrementally. The initial dialysis method to maintain residual renal function or QOL (ie : incremental dialysis) may contribute to improved outcomes in patients receiving early peritoneal dialysis initiation. | |