Optimal initiation of dialysis in end stage kidney disease patients: is it a resolved question? A Systematic Literature Review

Abstract

Abstract Is there a definite universally accepted optimal initiation of maintenance dialysis in end stage kidney disease patients (ESKD)? The decision on optimal initiation of maintenance dialysis is an ongoing common problem faced by nephrologists around he world. However, symptoms or signs of uremia are varied and complex, mainly depending on clinical judgment; what’s more, typical uremic symptoms such as pericarditis and encephalopathy in patients without volume overload often occur at a very low glomerular filtration rate (GFR) and these conditions are often combined with severe metabolic disorders and/or organ damages. The fact is that the exact optimal timing of dialysis for ESKD patients remains unknown. The study systematically reviewed the available evidence with regard to the optimal initiation of maintenance dialysis in ESKD patients, applying PRISMA and the Newcastle-Ottawa scale. The review identified approaches and methods for investigation of optimal dialysis initiation. Evidence suggests that GFR at dialysis initiation was not associated with mortality and that the timing of dialysis initiation should not be based on GFR. Assessments of volume load and patient’s tolerance to volume overload are prospective approaches recommended. The article updates and identifies approaches and methods for investigation of optimal dialysis initiation to support evidence-based clinical decision.