Education
Preparation for permanent access before initiation of HD
KDOQI 2015
GFR <30 (NG)
At least 6 months (2006, B)
JSDT 2015
GFR 15–30 (1D)
At least 1 month (2C)
ERBP 2011
GFR >15 and before their CKD becomes symptomatic (1C)
GFR >15 and before their CKD becomes symptomatic (1C)
When GFR <15
Decision to initiate maintenance dialysis | |
|---|---|
KDOQI 2015 | Uremic signs and/or symptoms |
Protein-energy wasting | |
Metabolic abnormalities | |
Volume overload hard to manage with medical therapy alone (not graded) | |
JSDT 2015 | Renal failure symptoms |
Daily life activities | |
Nutritional status | |
Which are not relievable without hemodialysis treatment (1D) | |
Should be initiated prior to GFR of 2 mL/min/1.73 m2, even if no symptoms (2C) | |
Should be considered if GFR <10 mL/min/1.73 m2, even if asymptomatic (2D) | |
ERBP 2011 | Symptoms or signs of uraemia, inability to control hydration status or blood pressure or a progressive deterioration in nutritional status (1A) |
A planned start to dialysis, while still asymptomatic in high-risk patients whose renal function is deteriorating rapidly and close supervision is not feasible (1C) | |
Dialysis membrane
Dialysis membrane and flux | |
|---|---|
KDOQI 2015 | Biocompatible , either high- or low-flux hemodialysis membranes for intermittent hemodialysis (1B) |
JSDT 2015 | High-performance membrane dialyzers should be used |
KHA-CARI 2013 | Either synthetic or cellulosic membranes be used for symptomatic intradialytic hypotension (1C) |
High-flux membranes to remove molecules such as beta-2 microglobulin (1A) | |
Possible survival benefits from high-flux membranes (1A):
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