Select Ion and Preparation of Patients for Dialysis

The prevalence of chronic kidney disease (CKD) is increasing [1]. This rise is probably attrib‐ utable to the progressively aging population and to the increased prevalence of comorbid conditions namely obesity, diabetes, and hypertension. According to the data from the Na‐ tional Health and Nutrition Examination Surveys, the prevalence of CKD in participants 70 years old and older is 46.8% compared to 6.7% in those between 40–59 years of age [1]. Many patients with CKD are unlikely to exhibit sufficient progressive decline in renal func‐ tion to require renal replacement therapy (RRT), in fact according to the findings present in literature only a small percentage of CKD patients ultimately require RRT [2-5]. In part, this low rate is explained by the increased risk of death from cardiovascular causes before pro‐ gression to end-stage renal disease (ESRD) can occur [6]. In part, it is secondary to the earlier referral than in the past to nephrologists with improvement of nondialytic maximum con‐ servative management (MCM) focused on quality of life and patient comfort (i.e. maximiz‐ ing renoprotective therapies, additional dietary interventions) [7,8]. In 2008, more than 110,000 Americans were started on maintenance RRT, a life-saving therapy for patients with ESRD [6]. Ideally, when patients begin RRT they should meet the following conditions: first‐ ly, they should not require hospitalization for the management of untreated acute or chronic complications of uraemia; secondly, they should have a thorough understanding of the dif‐ ferent treatment options; and thirdly, they should have a functioning, permanent access for the RRT of their choice [9].