ABSTRACT
The decision to initiate hemodialysis is a complex one. Many factors must be considered, and the patient must be fully involved. According to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI)™ guidelines, patients should be referred to a nephrologist when their glomerular ”ltration rate (GFR) is less than 30 (National Kidney Foundation, 2000). However, some patients have been shown to bene”t from earlier referral, whereas late referral to a nephrologist has been shown to be strongly associated with early death in patients with end-stage renal disease (Kessler et al., 2003). Patients with rapidly changing renal function, proteinuria, or evidence of glomerular disease should be immediately referred to a nephrologist. Nephrologists are able to evaluate the etiology of renal disease as well as treat the multiple comorbidities, thereby improving outcomes. Early referral to a nephrologist also allows the patient and nephrologist time to develop a relationship. It is essential that patients be fully educated about chronic kidney disease (CKD) and the expected progression of their disease. This allows for patient-centered care and patient participation in the decision-making process.
