It’s always hard in end stage renal failure to choose the optimal time to consider dialysis, although recently people having been moving more and more toward early dialysis. So, when to dialyse? NEJM has the answer – read on after the break.
This randomised controlled trial compared starting dialysis early, at a GFR of 10-15, or late, at a GFR of 5-7, and looked at mortality as the primary outcome. As you can see from the article, there was no real advantage to starting early – outcomes were pretty similar. It is important to note that over 75% of the late start group had to start dialysis earlier than planned due to the development of symptoms.
This is definitely going to generate some discussion – make sure you’re ahead of the curve by reading up here.