Friday, 14 February 2014

Canadian Society of Nephrology Changes Guidelines

A recent change to guidelines has appeared in the Canadian Medical Association Journal.

The articles talks about the timing of starting dialysis for sufferers of chronic kidney disease and how there is a need to identify a threshold before which starting dialysis offers no benefit to the patient but beyond which there may be some measurable risk.

Basically they suggest that a patient should not commence their dialysis treatment until their glomerular filtration rate drops to 6mL/minute per 1.73m2 or less, or clinical indications become evident. Close monitoring of the patient should begin when levels reach 15mL per minutes per 1.73m2

"Delaying dialysis in people without symptoms appears to be safe, as long as they are closely followed by their kidney specialist," lead author Gihad Nesrallah, MD, associate scientist at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, London, Ontario, Canada, said in a journal news release. "This approach is sure to be preferred by patients, who generally enjoy a better quality of life off dialysis than on it." 

THe spokesman also said that there did not seem to be any downside to delaying the start , assuming that it can be started promptly when required.

Apparently the report authors didn't consider any cost savings in making their guidelines, but did note that there would probably be a substantial saving made.

Previous guidelines placed more emphasis on laboratory tests than on patients' symptoms and recommended starting dialysis at higher eGFR rates for people with diabetes or a decline in nutritional status.

These recommendations were made after analysing 23 studies on  dialysis.