From the Guidelines
Initiating dialysis is crucial for patients with end-stage kidney disease as it offers several important benefits, including improved control of electrolyte imbalances, better management of fluid overload, and reduction of uremic symptoms, ultimately leading to a better quality of life and extended life expectancy 1.
Benefits of Dialysis
The benefits of dialysis include:
- Improved control of electrolyte imbalances (particularly potassium, phosphorus, and sodium)
- Better management of fluid overload that can cause hypertension and heart failure
- Reduction of uremic symptoms such as nausea, vomiting, fatigue, confusion, and pruritus
- Management of metabolic acidosis
- Improvement of nutritional status by reducing protein restrictions
Timing of Dialysis Initiation
The timing of dialysis initiation is typically based on a combination of laboratory values (particularly GFR below 15 ml/min), symptoms, and overall clinical status 1.
Lifestyle Adjustments
While dialysis requires significant lifestyle adjustments, including regular treatments (typically three times weekly for hemodialysis or daily for peritoneal dialysis), the benefits of removing toxins and maintaining homeostasis generally outweigh these challenges for patients with advanced kidney failure 1.
Quality of Life
For many patients, dialysis provides better quality of life by alleviating symptoms that interfere with daily activities.
Recent Guidelines
Recent guidelines suggest that the provision of RRT itself has become fairly well established, and modality choice should be tailored to patient clinical status 1.
From the Research
Benefits of Initiating Dialysis
The benefits of initiating dialysis for end-stage renal disease (ESRD) patients are not explicitly stated in the provided studies. However, some studies suggest that dialysis can improve mortality rates and quality of life for patients with ESRD 2, 3, 4.
Improved Mortality Rates
- Controlling blood pressure in patients receiving dialysis improves mortality 2.
- Volume control through adequate dialysis and sodium restriction can help optimize hypertension treatment in these patients 2.
- However, one study found that one-year mortality for ESRD patients initiating dialysis was 33.8% 5.
Quality of Life
- Dialysis initiation and its timing should be a shared decision between physician, patients, and family members, and should be tailored to the individual patient's needs 3.
- Patients should be monitored for signs of protein-energy wasting and malnutrition 2.
- Palliative care and hospice referral are indicated for patients who decide against renal replacement therapy (RRT) or opt for supportive care 4.
Timing of Dialysis Initiation
- The decision to initiate dialysis should not be based solely on estimated glomerular filtration rate (eGFR) 3.
- Early dialysis initiation is not associated with a morbidity and mortality benefit, as shown in the Initiating Dialysis Early and Late (IDEAL) study 3.
- In asymptomatic patients with stage 5 chronic kidney disease, dialysis may be safely delayed until the eGFR is at least as low as 5-7 mL/min/1.73 m2 if there is careful clinical follow-up and adequate patient education 3.