End-stage kidney failure, tasks in predialytic stadium, dialysis forms and indications

1. Big picture

End-stage kidney failure is the final stage of chronic kidney disease (CKD), where kidney function is no longer sufficient to maintain fluid, electrolyte, acid-base, endocrine, and toxin balance without renal replacement therapy or carefully planned conservative management.

For the oral exam, think in this order:

Progressive CKD
   ↓
Predialysis care: slow progression + treat complications + prepare access/transplant
   ↓
Indications appear: uremia, refractory hyperkalemia/acidosis/overload, malnutrition
   ↓
Choose renal replacement therapy:
hemodialysis / peritoneal dialysis / kidney transplantation

Dialysis should not be started from a creatinine value alone. KDIGO recommends starting dialysis based on a combined assessment of symptoms, signs, quality of life, patient preference, glomerular filtration rate (GFR), and laboratory abnormalities; this often occurs when GFR is approximately 5–10 mL/min/1.73 m², but not always.

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