According to the Canadian Society of Nephrology guidelines, what criteria are used to determine when dialysis should be initiated in chronic kidney disease (CKD)?

Updated: Jul 21, 2021
  • Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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In February 2014, the Canadian Society of Nephrology released new guidelines that recommend delaying dialysis in CKD patients without symptoms until their estimated glomerular filtration rate (eGFR) drops to 6 mL/min/1.73 m2 or until the first onset of a clinical indication (which includes uremia, fluid overload, and refractory hyperkalemia or acidemia). [52, 53] To ensure prompt recognition of that threshold, close monitoring should begin when eGFR reaches 15 mL/min/1.73 m2. Additional factors that may affect dialysis initiation include patient education and modality selection, the severity of existing uremic symptoms, and the rate of renal function decline. [52, 53]

Patients with CKD acutely presenting with indications for dialytic therapy should be transferred to a hospital center where acute dialysis can be performed.

The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) has issued several clinical practice guidelines for managing all stages of CKD and related complications in adults.

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