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The Essentials of Clinical Dialysis pp 3–22Cite as

Dialysis Indication and Initiation Time for Dialysis

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Abstract

Some chronic kidney disease patients experience deterioration of renal function which requires artificial support for the kidney functions, or renal replacement therapy. This condition is called as end-stage renal disease (ESRD). For ESRD patients, the timing of initiation of dialysis therapy is critical. Historically, the earlier initiation of dialysis was considered beneficial in terms of maintenance of nutritional status or quality of life of the patients because such earlier initiation shortens the period during which the patient suffers from the uremic environment. However, many studies have demonstrated that the survival of the patients was not better who started dialysis therapies at the higher glomerular filtration rate. The only randomized controlled trial, IDEAL study, also failed to demonstrate the optimal timing of dialysis initiation. On the other hand, the existence of uremic symptoms, nutritional deterioration, and comorbidities should be considered in starting dialysis. Published guidelines regarding initiation of dialysis therapy advocated the importance of these points. Moreover, the pre-dialysis cares, including vascular access placement at an appropriate timing, are crucial for the better prognosis after starting dialysis therapy. Therefore, the appropriate pre-dialysis cares together with close monitoring of uremic symptoms are indispensable to determine the timing of dialysis initiation.

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  1. Department of Blood Purification, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan

    Norio Hanafusa M.D., Ph.D.

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  1. Norio Hanafusa M.D., Ph.D.
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Correspondence to Norio Hanafusa M.D., Ph.D. .

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  1. Division of Nephrology, Kyungpook National University Hospital, Daegu, Korea (Republic of)

    Yong-Lim Kim

  2. Tsuchiya General Hospital, Hiroshima, Japan

    Hideki Kawanishi

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Hanafusa, N. (2018). Dialysis Indication and Initiation Time for Dialysis. In: Kim, YL., Kawanishi, H. (eds) The Essentials of Clinical Dialysis. Springer, Singapore. https://doi.org/10.1007/978-981-10-1100-9_1

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