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Initiation of dialysis.

R M Hakim and J M Lazarus
JASN November 1995, 6 (5) 1319-1328;
R M Hakim
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J M Lazarus
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Abstract

The decision to initiate dialysis in a patient with progressive renal disease often depends on the physician's assessment of the patient's subjective symptoms of uremia. There is an increasing need to identify objective criteria for such a decision. Recent evidence suggests that malnutrition at the initiation of dialysis is a strong predictor of subsequent increased relative risk of death on dialysis. In this context, the role of prescribed protein restriction as well as the influence of the progression of renal disease on spontaneous dietary protein intake is examined. It is proposed that the indices of malnutrition such as progressive weight loss, serum albumin levels below 4.0 g/dL, serum transferrin levels below 200 mg/dL, and spontaneous dietary protein intake (using 24-hr urinary nitrogen measurement) below 0.8 to 0.7 g/kg per day be considered as objective criteria for the initiation of dialysis. Studies that have examined the role of "early" versus "late" dialysis have consistently shown a better outcome in the patients starting dialysis early. Other studies also suggest that early referral to nephrologists results in improved morbidity and mortality as well as hospitalization costs. An adequate vascular access, as well as social and psychological preparation of the patient, is an important early step in the process.

  • Copyright © 1995 by American Society of Nephrology
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Journal of the American Society of Nephrology
Vol. 6, Issue 5
1 Nov 1995
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Initiation of dialysis.
R M Hakim, J M Lazarus
JASN Nov 1995, 6 (5) 1319-1328;

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Initiation of dialysis.
R M Hakim, J M Lazarus
JASN Nov 1995, 6 (5) 1319-1328;
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Cited By...

  • Symptom Management of the Patient with CKD: The Role of Dialysis
  • Non-Invasive Potentiometric Sensor for Measurement of Blood Urea in Human Subjects Using Reverse Iontophoresis
  • Uncorrected and Albumin-Corrected Calcium, Phosphorus, and Mortality in Patients Undergoing Maintenance Dialysis
  • Early Start of Dialysis: A Critical Review
  • Timing of Dialysis Initiation and Survival in ESRD
  • Long-term outcome on renal replacement therapy in patients who previously received a keto acid-supplemented very-low-protein diet
  • Exploring Secular Trends in the Likelihood of Receiving Treatment for End-Stage Renal Disease
  • Diets For Patients With Chronic Kidney Disease, Still Worth Prescribing
  • Impact of Timing of Initiation of Dialysis on Mortality
  • Insights into the Abnormalities of Chronic Renal Disease Attributed to Malnutrition
  • Specialist follow up of patients before end stage renal failure and its relationship to survival on dialysis
  • Renal Function and Nutritional Status at the Start of Chronic Dialysis Treatment
  • Late Initiation of Dialysis among Women and Ethnic Minorities in the United States
  • Nutrition and Outcome on Renal Replacement Therapy of Patients with Chronic Renal Failure Treated by a Supplemented Very Low Protein Diet
  • Prevalence, Predictors, and Consequences of Late Nephrology Referral at a Tertiary Care Center
  • Recent advances :General management of end stage renal disease
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