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Chronic Kidney Disease (CKD) is characterized by an insidious, irreversible, and slow progression, and it presents an increasing prevalence on a global scale, with estimates indicating that 8% to 16% of the world's adult population may be affected by some form of this condition. Dialysis, while representing a crucial therapeutic resource and a significant advancement in medicine for maintaining the lives of patients with renal insufficiency, also implies a significant and often devastating impact on the quality of life (QoL) of these individuals. This impact permeates various aspects of patients' daily lives, affecting their physical, psychological, and social well-being.
A qualitative exploratory study in which randomized clinical trials and/or observational studies focused on patients undergoing dialysis due to chronic renal insufficiency were selected. Renowned databases, such as the Medical Literature Analysis and Retrieval System Online (Medline - PubMed), Scientific Electronic Library Online (SciELO), Google Scholar, and BVS, were used as sources of research.
46 papers were analyzed, and after filtering titles and abstracts, 37 papers were included. The scientific literature shows significant variability in determining the appropriate time to initiate dialysis in patients with CKD. This inconsistency is reflected in the different parameters used, including eGFR, plasma levels of creatinine and urea, and other renal biomarkers. From the analysis of clinical trials, it was noted that early initiation may be associated with a modest reduction in mortality and cardiovascular events, but without significant variations. Therefore, the scientific literature highlights significant variability in determining the appropriate time to initiate dialysis in CKD patients, which requires an analysis not only of values related to eGFR, creatinine, urea, and other renal biomarkers but also the psychoemotional evaluation of the patient. Dialysis therapy is associated with the manifestation of complications such as cardiovascular risks, infections, electrolyte imbalances, bone dysfunction, pain, among others. Regarding post-dialysis mortality, research has highlighted the correlation between factors such as advanced age, the presence of comorbidities (particularly cardiovascular diseases and diabetes), and certain biochemical abnormalities with adverse outcomes.
The implementation of dialysis in patients diagnosed with CKD is a pivotal milestone that emphasizes the need to adopt individualized therapeutic strategies, taking into account not only biochemical indicators but also the clinical picture, symptoms, and comorbidities of each patient. The choice to initiate dialysis should consider the balance between quality of life (QoL), life expectancy, and the potential intrinsic risks of the procedure. The nature of the decision about dialysis underscores the need for an interdisciplinary approach, bringing together nephrologists, nurses, psychologists, and other healthcare professionals. In this regard, it is essential that management and treatment strategies be continuously evaluated and improved, prioritizing a holistic and individualized approach to renal patient care.