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| INITIATION OF DIALYSIS |
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| Author(s): HAKIM RM, LAZARUS JM |
| Source: JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY Volume: 6 Issue: 5 Pages: 1319-1328 Published: NOV 1995 |
| Times Cited: 135 References: 64 |
| Abstract: The decision to initiate dialysis in a patient with progressive renal disease often depends on the physician's assessment of the patient's subjective symptoms of uremia. There is an increasing need to identify objective criteria for such a decision. Recent evidence suggests that malnutrition at the initiation of dialysis is a strong predictor of subsequent increased relative risk of death on dialysis, In this context, the role of prescribed protein restriction as well as the influence of the progression of renal disease on spontaneous dietary protein intake is examined. It is proposed that the indices of malnutrition such as progressive weight loss, serum albumin levels below 4.0 g/dL, serum transferrin levels below 200 mg/dL, and spontaneous dietary protein intake (using 24-hr urinary nitrogen measurement) below 0.8 to 0.7 g/kg per day be considered as objective criteria for the initiation of dialysis. Studies that have examined the role of ''early'' versus ''late'' dialysis have consistently shown a better outcome in the patients starting dialysis early. Other studies also suggest that early referral to nephrologists results in improved morbidity and mortality as well as hospitalization costs. An adequate vascular access, as well as social and psychological preparation of the patient, is an important early step in the process. |
| Document Type: Review |
| Language: English |
| Reprint Address: HAKIM, RM (reprint author), VANDERBILT UNIV, MED CTR, DIV NEPHROL, 1161 21ST AVE S & GARLAND, S-3307 MCN, NASHVILLE, TN 37232 USA |
Addresses:
1. BRIGHAM & WOMENS HOSP, BOSTON, MA 02115 USA |
| Publisher: WILLIAMS & WILKINS, 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 |
| Subject Category: Urology & Nephrology |
| IDS Number: TF752 |
| ISSN: 1046-6673 |
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| | | | | | | | | Record from Web of Science® | | | | | | | | | |