Which criterion is used to determine when a dialysis would be initiated in a patient with end stage renal disease
The correct answer and explanation is:
Correct Answer: Presence of uremic symptoms and/or significant decline in kidney function (usually eGFR <10 mL/min/1.73 m²)
Dialysis is initiated in patients with end-stage renal disease (ESRD) when conservative management is no longer effective in maintaining homeostasis and the patient begins to show symptoms or signs of severe kidney failure. While a numerical threshold such as an estimated glomerular filtration rate (eGFR) below 10 mL/min/1.73 m² is often used as a guide, clinical symptoms and complications are the main determining factors.
The key criterion is the presence of uremic symptoms, which include fatigue, confusion, nausea, vomiting, anorexia, pruritus (itching), and signs of pericarditis or encephalopathy. These symptoms result from the accumulation of waste products and toxins that healthy kidneys would normally eliminate. Additional indications for starting dialysis include uncontrolled fluid overload, persistent hyperkalemia, severe metabolic acidosis, or difficulty in managing blood pressure despite medication.
Another factor is the inability to maintain electrolyte and fluid balance with diet and medications alone. If the kidneys can no longer remove enough potassium, manage fluid levels, or maintain acid-base balance, dialysis becomes necessary to prevent life-threatening complications.
Patients with eGFR levels between 5 and 10 mL/min/1.73 m² may not need immediate dialysis if they are stable and asymptomatic. However, once symptoms or complications arise, dialysis should be started regardless of the precise eGFR value. Clinical judgment based on the patient’s symptoms, overall condition, and laboratory values is more important than a strict numerical threshold.
In summary, the initiation of dialysis in ESRD depends primarily on the clinical presentation, not just lab numbers. It is guided by the development of uremic symptoms, fluid or electrolyte imbalances, and declining quality of life that cannot be managed conservatively.