CARI-Australia
November 2003
|
- Start dialysis when
GFR <10ml/min/1.73m2 if there is evidence of uraemia
or complications such as malnutrition. In occasional patients it
may be necessary to initiate dialysis at a higher GFR.
- If there is no evidence of uraemia or its complications,
commence dialysis when GFR <6ml/min/1.73m2.
- Start dialysis whenever signs of malnutrition
-Absolute and relative indications are a historical concept
|
Dialysis Guidelines.
Acceptance onto dialysis.
6. Level of renal function at which to initiate dialysis
Other criteria for starting dialysis
For rationale, each time read below the guidelines. |
Evidence
level B
Evidence level III
Evidence level III |
CSN-Canada
1999 |
- When GFR <120L/wk per
1.73m2 (12ml/min), look for symptoms or signs of uraemia or
evidence of malnutrition. If uraemia or protein equivalent of
nitrogen appearance (PNA = protein intake) <0.8g/kg per d or
clinical malnutrition, recommend dialysis.
- If no evidence of uraemia or malnutrition, increase the
frequency of observation to monthly and recommend dialysis when
indicated.
- When GFR <60L/wk per 1.73m2 or 6ml/min, recommend initiation
of dialysis. |
Guideline 1.3 Initiation of dialysis p 4-5 of 35 PDF pages.
For rationale, read below the guidelines. |
Evidence
level IV
GFR of 12 ml/min corresponds to Ccreat of 18ml/min or renal
Kt/V of 2.0
Opinion
Opinion |
EBPG-Europe
November 2002 |
- Dialysis
should be instituted whenever the GFR <15ml/min and there is one
or more of the following: symptoms or signs of uraemia,
inability to control hydration status or blood pressure or a
progressive deterioration in nutritional status.
- Dialysis should be started before GFR ≤6ml/min/1.73m2
even if optimal pre-dialysis care has been provided and there
are no symptoms.
- High-risk patients e.g. diabetics may benefit from an earlier
start.
- To ensure that dialysis is started before GFR<6ml/min, clinics
should aim to start at 8-10ml/min. |
1.3 When to start dialysis |
Evidence
level C
Evidence level C
Evidence level C
Evidence level C |
KDOQI-US
February 2004 |
- Patients should be
advised to initiate dialysis when renal Kt/V urea /week <2.
- The conditions that indicate dialysis as not yet necessary
are: stable or increased edema) free body weight, complete
absence of clinical signs or symptoms.
- If protein malnutrition develops and there is no apparent
cause other than low nutrient intake, dialysis should be
recommended. |
Guideline 1: When to Initiate Dialysis-Kt/Vurea Criterion |
Opinion
Renal Kt/V urea of 2.0 corresponds to a GFR of 10.5 ml/min/1.73m2
Opinion |
UK-Guidelines
August 2002 |
- Dialysis should be
considered when the weekly CUrea < renal Kt/Vurea of <2.0 (GFR
14ml/min). Dialysis will be indicated if there is evidence of
malnutrition or if symptoms interfere with quality of life. It
is prudent to consider dialysis at this early stage in those
with predictable steadily progressive renal failure as occurs in
polycystic disease or glomerulonephritis. Those with stable
renal function, however, may often be treated conservatively. |
10. The management of patients approaching ESRD
p 165-166 of 204 PDF pages
|
Good
practice |
