Repercusiones del inicio temprano y del inicio tardío de la diálisis

Ortega, L.M.; Nayer, A.

doi:10.3265/Nefrologia.pre2011.Mar.10795

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A pesar de que el uso de la diálisis crónica está muy extendido, aún no existe consenso en cuanto a cuál es el mejor momento para comenzar el tratamiento renal sustitutivo, por lo que se suelen utilizar como referencia las recomendaciones de la Iniciativa para la Calidad de los Resultados de la Insuficiencia Renal de la Fundación Nacional del Riñón (NKF-KDOQI). Esto ha provocado que durante la última década hay surgido una tendencia a iniciar la diálisis antes, especialmente en el caso de las personas de edad avanzada, lo que ha conllevado a una reducción considerable de las tasas de supervivencia, debido a la mayor carga de comorbilidades que sufre esta población. Los datos de estudios de cohorte retrospectivos han sido corroborados por el ensayo controlado aleatorizado que se ha realizado recientemente en Australia y Nueva Zelanda, el estudio IDEAL. Este estudio tiene ciertas limitaciones, ya que existen diferentes factores de confusión que afectan a la población estudiada. Nuestro trabajo es una revisión basada en la evidencia que se centra en la reducción de las tasas de supervivencia que se ha producido con el inicio temprano de la diálisis.

Palabras clave:

Dialisis peritoneal

Palabras clave:

Malnutrición

Palabras clave:

Filtrado glomerular

Palabras clave:

Hemodialisis

Palabras clave:

Mortalidad

Despite the widespread use of chronic dialysis, there remains a lack of consensus about the optimal time for initiation of renal replacement therapy. Recommendations from the National Kidney Foundation Kidney Disease Outcome Quality Initiative are generally used as the guideline. This has resulted in a trend in the past decade toward earlier initiation of dialysis, especially in the elderly. The associated burden of comorbidities in the elderly population has resulted in greatly reduced survival outcomes. Here, the data obtained from retrospective cohort studies have been corroborated with a recent randomized control trial conducted in Australia and New Zealand (IDEAL study). There are limitations to consider from the IDEAL study that originate from different confounding factors that intervene in the test population. The present paper is an evidence-based review of the literature, focusing on diminution of survival outcomes following the early initiation of dialysis.

Keywords:

Peritoneal dialysis

Keywords:

Malnutrition

Keywords:

Glomerular filtration rate

Keywords:

Hemodialysis

Keywords:

Mortality

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Bibliografía

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