Major Research Findings

Research on the timing of dialysis initiation has shown that early initiation leads to better outcomes than delayed initiation. Early referral patients had fewer serious comorbidities and were more likely to have hereditary renal disease, while delayed referral patients had more serious comorbidities and many were noncompliant with follow-up. Renal function was slightly worse at initiation in those referred late. 1

Studies on the association between residual renal function at dialysis initiation and nutritional status have shown that a decreased glomerular filtration rate (GFR) is associated with lower protein intake. Poor nutritional status is linked to reduced survival in both incident and prevalent dialysis patients. However, one study reported excellent patient survival among those who started dialysis late after receiving a supplemented low-protein diet and were not malnourished at dialysis initiation. 1

Research on the association between GFR at dialysis initiation and clinical outcomes has found that a lower GFR at dialysis initiation is associated with an increased risk of hospitalization and death. 1

A randomized controlled trial comparing hemodiafiltration (HDF) with high-flux hemodialysis (HD) found that HDF resulted in shorter recovery times after treatment. Shorter recovery times are associated with lower mortality rates and improved quality of life, making this information crucial for patients in making treatment choices. 10

Treatment Summary

Based on current evidence, dialysis initiation is recommended when the creatinine clearance rate (Ccr) reaches 9 to 14 mL/min, especially if there is clinical or laboratory evidence of malnutrition. 1

Continuous ambulatory peritoneal dialysis (CAPD) is a viable alternative to hospital or home hemodialysis for patients with end-stage renal disease (ESRD). 4

The reduction of hemodialysis treatment time may not be harmful to patients if solute clearance is maintained. 3

Benefits and Risks

Benefits Summary

The benefits of dialysis include increased survival rates, reduced risk of serious complications, and improved quality of life.

Risks Summary

Dialysis carries risks such as an increased risk of hospitalization and death, malnutrition, anemia, osteoporosis, infections, and other complications.

Comparison Between Studies

Commonalities in Studies

Many studies examine the timing of dialysis initiation, types of dialysis, treatment duration, and dialysis effectiveness.

Differences in Studies

Studies differ in their target patient populations, research designs, and assessment criteria.

Consistency and Contradictions in Results

Some contradictions exist within dialysis research. For example, while some studies suggest that shorter hemodialysis treatment times are not harmful if solute clearance is maintained, others indicate a possible negative impact from shorter treatment durations.

Considerations for Real-Life Applications

Applying dialysis research to real-life situations requires careful consideration of each patient's unique circumstances. For instance, when deciding on the timing of dialysis initiation, factors such as the patient's age, comorbidities, and residual renal function must be taken into account.

Limitations of Current Research

Dialysis research is limited by a lack of randomized controlled trials. Therefore, careful interpretation of the research findings is necessary.

Future Research Directions

Further research on dialysis is crucial, particularly randomized controlled trials. Long-term impact studies are also needed.

Conclusion

Dialysis is a critical life-saving treatment for individuals with kidney failure. However, it involves risks, so choosing the most appropriate treatment method for each patient requires careful consideration. Continued research on dialysis holds the promise of developing safer and more effective treatment options for patients.

Treatment List

Hemodialysis, peritoneal dialysis, hemodiafiltration, nocturnal every-other-day online hemodiafiltration.