JOURNAL ARTICLE
REVIEW

Early start peritoneal dialysis

Carol A Pollock, Bruce A Cooper, David C Harris
Advances in Chronic Kidney Disease 2007, 14 (3): e27-34
17603972
The timing of commencement of dialysis is controversial, as it has an impact on the patient's lifestyle, the dialysis capacity of renal services, and costs to both the individual and community. In patients with chronic kidney disease, the commencement of dialysis based on clinical features of uremia and laboratory indices that mandate dialysis therapy may not optimize outcomes. Currently reported studies are subject to potential confounding factors, including lead-time bias, the timing of referral, uniform predialysis care, patient age, comorbidity, and compliance. Despite the lack of supporting evidence, national and international expert panels have generally recommended adopting guidelines that support the initiation of dialysis at levels of kidney function that are higher than observed in current practice. No compelling evidence supports the initial use of one modality of dialysis over another, but initiation of peritoneal dialysis will likely preserve residual kidney function to a greater extent than will initiation of hemodialysis. As preservation of endogenous kidney function is an important goal in patients with end-stage kidney disease, this outcome may contribute to the choice of modality. Objective parameters that will guide the initiation of dialysis to maximize survival, reduce morbidity, and inform as to the economic benefit of implementing such practice will be available when the Initiating Dialysis Early and Late (IDEAL) study reports in 2009.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
17603972
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"