NDT-EDUCATIONAL

Dialysis for chronic kidney disease can be delayed: new guideline recommendation

For asymptomatic adults with chronic kidney disease who will need dialysis, an intent-to-defer approach is recommended over an earlier start, according to a new guideline from the Canadian Society of Nephrology published in CMAJ (Canadian Medical Association Journal).

The guideline panel recommends an "intent-to-defer" strategy over an "intent-to-start" early approach, in which patients with an estimated glomerular filtration rate (eGFR) below 15 mL/ min per 1.73 m2 are closely monitored by a nephrologist. Dialysis is initiated when clinical indications emerge or the eGFR is 6 mL/min per 1.73 m2 or less, whichever of these occurs first.

The recommendation is based on evidence from 23 studies, including the Initiating Dialysis Early and Late (IDEAL) study, a large recent clinical trial that looked at survival rates, costs and other factors in early versus deferred start of dialysis. The study also found that there were substantially higher costs per patient with early initiation of dialysis.

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