Holly M. Koncicki, MD

Older adults with end-stage kidney disease had “modest gains” in life expectancy by starting on dialysis vs. choosing continuing medical management but spent less time at home, results from study show.

A common challenge nephrologists encounter is deciding when to start patients on dialysis. Clear indications exist, such as life-threatening metabolic abnormalities, refractory volume overload or uremic complications, though sometimes dialysis is initiated earlier due to uremic symptoms.1 Strong evidence is lacking to show the efficacy of dialysis in decreasing uremic symptoms. Despite being initiated on dialysis, many patients with ESRD continue to experience a large symptom burden.