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Indications of initiation renal replacement therapy among patients with chronic renal disease

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Alexandra Florou, Nikoleta Margari, Dimitrios Theofanidis
Alexandra Florou, Nikoleta Margari, Dimitrios Theofanidis


Introduction: Chronic renal failure (CRF) is a major cause of morbidity and mortality and renal replacement dialysis is necessary for the preservation of life, despite the fact that it is characterized by multiple restrictions and complications.

Aim: The purpose of the present systematic review was the investigation of the absolute and relevant renal replacement therapy initiation criteria among patients with end-stage renal disease (ESRD).

Material and Method: There was an extensive research at Pubmed, IATROTEK and Cinahl during the period 2000-2015. The key words that were used for data search included “CRF”, “renal replacement therapy”, “initiation criteria”, “glomerular filtration rate”, and “guidelines”. In the present review, 20 studies were included. 

Results: Renal replacement therapy initiation constitutes a challenge for both nephrologists and patients since there is no consensus regarding the initiation criteria. GFR should not be the only marker for the initiation of renal replacement therapy since it is influenced by multiple factors. Renal replacement therapy should start at the presence of uremic signs and symptoms or complications, and co morbidity and individualized characteristics of patients should be taken into account. The doctors’-nephrologists’ characteristics seemed to influence the time of initiation of renal replacement therapy.

Conclusions: CRF patients should be monitored by an interdisciplinary team and for the decision for the renal replacement therapy initiation, a relationship of cooperation between the doctor and the patient should be encouraged.


Chronic renal failure; indications; criteria; decision making

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