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Dialysis is an approach to eliminate waste products in kidney failure patients and reduce complications in the patients. For the patients with kidney failure, early initiation of dialysis may help for protect main organs such as brain, heart, etc. However, early starting dialysis is not good for protecting residual renal functions. Well then, what is the proper time to start dialysis? At what creatinine level should dialysis be taken into consideration?
With kidney condition progressing, more and more metabolic wastes (such as creatinine and blood urea nitrogen) will build up in the body. Those harmful toxins circulate with bloodstream to damage multiple body systems, such as gastrointestinal tract, skin, cardiovascular tract, etc. Generally, when serum creatinine rises over 707umol/l, blood urea nitrogen approximates to 30mmol/l, or blood potassium higher than 6.5mmol/l, dialysis should be started immediately. However, even if not any of the indexes reach the above mentioned levels, if one experiences severe complications, including severe nausea, vomiting, swelling, or irreformable metabolic acidosis, heart failure, etc, dialysis should also be initiated at once.
On the other hand, even if both one’s creatinine and BUN are higher than the mentioned range, if one don’t have obvious complications of renal failure like heart failure and uremic cerebropathy, the patient can continue non-dialysis treatment. For those with blood potassium>6.5mmol/l, if potassium can be lowered within 5.5mmol/l by other treatments, they can also put off dialysis. Clinically, people with Diabetes and hypertension generally start dialysis earlier than others because they tend to experience earlier and more complications than others.
All in all, there is not a criterion which can be applied to all occasions as to when dialysis should be started. Doctors will propose suggestions based on the patient’s specific illness condition, and the decision will be made after communication between the family members and the doctors.
