Journal of Nephrology

, Volume 29, Issue 2, pp 153–161 | Cite as

Stage 5-CKD under nephrology care: to dialyze or not to dialyze, that is the question

  • Mario Pacilio
  • Roberto Minutolo
  • Carlo Garofalo
  • Maria Elena Liberti
  • Giuseppe Conte
  • Luca De Nicola


Appropriate timing of starting chronic dialysis in patients with advanced chronic kidney disease (CKD) under nephrology care still is undefined. We systematically reviewed the most recent studies that have compared outcomes of stage 5-CKD under conservative versus substitutive treatment. Eleven studies, most in elderly patients, were identified. Results indicate no advantage of dialysis over conservative management in terms of survival, hospitalization or quality of life. This information is integrated with a case report on a middle-aged CKD patient followed in our clinic who has remained for 15 years in stage 5 despite severe disease. The patient is a diabetic woman who underwent right nephrectomy in 1994 because of renal tuberculosis. In 1999, she commenced regular nephrology care in our clinic and, since 2000, when she was 53 years old, her estimated glomerular filtration rate (eGFR) has been ≤15 ml/min/1.73 m2. Over the last decade, despite, several episodes of acute kidney injury and placement of permanent percutaneous nephrostomy in 2001, renal function has remained remarkably stable, though severely impaired (eGFR 7.7–5.6 ml/min/1.73 m2). Our systematic analysis of the literature and this case report highlight the need for further studies, not limited exclusively to elderly patients, to verify the efficacy of non-dialysis treatment in stage 5-CKD patients. Meanwhile, nephrologists may consider that their intervention can safely prolong for several years the dialysis-free condition in ESRD independently of age.


CKD Systematic review Case report Diabetic kidney disease Proteinuria Nephrology care 


Compliance with ethical standards

Conflict of interest

The authors have no potential conflict of interest.

Ethical approval

This article does not contain any study with human participants or animals performed by any of the authors.

Informed consent

Patient gave informed consent to report her clinical case on a scientific journal.

Supplementary material

40620_2015_243_MOESM1_ESM.pdf (67 kb)
Supplementary material 1 (PDF 66 kb)


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Copyright information

© Italian Society of Nephrology 2015

Authors and Affiliations

  • Mario Pacilio
    • 1
  • Roberto Minutolo
    • 1
  • Carlo Garofalo
    • 1
  • Maria Elena Liberti
    • 1
  • Giuseppe Conte
    • 1
  • Luca De Nicola
    • 1
  1. 1.Nephrology DivisionSecond University of Naples-Med School, S.M.d.P Incurabili HospitalNaplesItaly

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