Sydney Medical School - Western, University of Sydney at Westmead Hospital, Sydney, New South Wales, Australia.
Nephrology (Carlton). 2010 Jun;15 Suppl 2:61-5. doi: 10.1111/j.1440-1797.2010.01316.x.
Recommendations about when to initiate dialysis for end-stage kidney failure have been made by a number of expert groups. These recommendations have led to changes in clinical practice, yet they are not based on high level evidence. In fact, most reported studies argue that dialysis should be started early rather than late, many are confounded and a number have reached the opposite conclusion. Probably more important than a prescribed level of renal function at which dialysis is initiated is the widespread adoption of a structured approach to pre-dialysis care and the recognition of the importance of pre-dialysis patient education. One of the main determinants of optimal initiation of dialysis is the time of referral of the patient to a nephrologist or a renal unit. In particular, early referral of patients with chronic kidney disease allows a planned initiation of dialysis, using from the start permanent vascular or peritoneal dialysis access.
一些专家组已经就终末期肾衰竭开始透析的时机提出了建议。这些建议导致了临床实践的改变，但它们不是基于高级别的证据。事实上，大多数报道的研究都认为，透析应该早开始而不是晚开始，许多研究存在混杂因素，而且有些研究得出了相反的结论。可能比规定的开始透析的肾功能水平更重要的是广泛采用透析前护理的结构化方法，并认识到透析前患者教育的重要性。最佳开始透析的主要决定因素之一是患者向肾脏病专家或肾脏科就诊的时间。特别是，对慢性肾脏病患者的早期转诊可以使用永久性血管或腹膜透析通路，从一开始就计划开始透析。
