Resumen
There is a trend in the last decade for an increase in early initiation in renal replacement therapy in the United States. In 1996 19% of patients initiated dialysis with an estimated glomerular fltration over 10 ml/min/1,73m2 percentage that actually has increase to 45%. This review will show the reasons and evidence behind the current tendencies. There is no factual evidence to support the claim of the benefcial effects in early dialysis starts. Data so far shows increase mortality in early dialysis, unrelated to the co-morbidities of patients with advanced chronic kidney disease. Residual renal function could also be affected by early initiation of dialysis, hampering survival in the long run. Finally will be showing the fnancial burden to the health system. Randomized clinical trials are needed to answer these questions.
Key words: Hemodialysis. Chronic renal failure. End stage kidney disease. Renal replacement therapy.
Referencias
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