Dialysis therapy and transplantation in uremia: which to use when.

In the United States, 10,000 to 18,000 new patients require therapy for end-stage renal disease each year. A combination of medical and psychosocial criteria can be used to predict whether renal transplantation or maintenance hemodialysis or peritoneal dialysis may be the most efficacious treatment. In most cases, dialysis therapy should be initiated when signs and symptoms of uremia are only subtle, usually when creatinine clearance is between 3 and 6 ml/min. One mode of therapy can be exchanged for another to suit changing needs, and vascular access should be created even in patients who ultimately will undergo peritoneal dialysis or receive a transplant.