Nephrol Dial Transplant (2001) 16: 1132-1138
© 2001 European Renal Association-European Dialysis and Transplant Association
Congress Report
Initiation of dialysis—opinions from an international survey: Report on the Dialysis Opinion Symposium at the ERA-EDTA Congress, 18 September 2000, Nice
1 Gambro Research, Lund, Sweden, 2 Centre Hospitalier Universitaire, Hôpitaux de Brabois, Nancy, France, 3 University Hospital, Gent, Belgium, 4 University Hospital, Würzburg, Germany, 5 Silesian University Medical School, Katowice, Poland, 6 McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada, 7 Institut de Génétique Humaine (IGH-CNRS) and University Hospital, Montpellier, France, and 8 University of Heidelberg, Heidelberg, Germany
Keywords: early start; initiation of dialysis; late referral; predialysis management
Introduction
Traditionally, dialysis therapy has been initiated only when considered absolutely necessary; when the remaining renal function is so low that the uraemic syndrome is becoming insupportable or even life-threatening. Such clinical practice can be justified from a medical, a psychological and a socio-economic point of view. It has been believed that the longer the burden of dialysis is postponed, the better for the patient and for society. However, evidence now suggests that malnutrition in renal disease patients develops along with the progression of renal failure, since patients adapt to the lower renal function by reducing their protein intake [1]. Other studies show strong correlation between nutritional status at the start of dialysis and outcome on dialysis [2]. Thus, it has been suggested that starting dialysis at a higher renal clearance than is normally practised, before uraemia and malnutrition have taken their toll, would have a beneficial
What determines the time for initiation of dialysis?
Comments by M. Kessler
What is the reason for delayed start of dialysis?
Comments by W. van Biesen
Advantage of an early start on dialysis
Comments by C. Wanner
Disadvantage of an early start on dialysis
Comment by A. Wiecek
Patient selection for an early start of dialysis
Comment by S. Prichard
Predialysis intervention
Comment by A. Argiles
General discussion
Notes
References
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