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NDT Plus 2008 1(Supplement 4):iv7-iv13; doi:10.1093/ndtplus/sfn117
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

This article appears in the following NDT Plus issue: Dialysis Initiatives May 2007, Berlin, Germany [View the issue table of contents]

Optimal predialysis care

Yvo W. J. Sijpkens, Noeleen C. Berkhout-Byrne and Ton J. Rabelink

Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands

Correspondence: Y. W. J. Sijpkens, Department of Nephrology, C3P, Leiden University Medical Center, Box 9600, 2300 RC Leiden, The Netherlands. Tel: +003-171-5262169; Fax: +003-171-5266868; E-mail: Y.W.J.Sijpkens{at}lumc.nl


  Abstract

Management of severe chronic kidney disease (CKD) involves dealing with medical, nursing and psychosocial problems and therefore warrants support from a multidisciplinary team. In the Kidney Disease Outcomes Quality Initiative (KDOQI) classification system of CKD, preparation for renal replacement therapy has been recommended in CKD stage 4, characterized by a reduction in the estimated glomerular filtration rate (GFR) of <30 ml/min. In this article we share our approach to perfecting predialysis care. Tools are given to make an estimation of the progression of kidney disease. Also the prevention and treatment of metabolic complications and cardiovascular risk management are summarized. Finally, the possibilities for dialysis but even more important, aiming for pre-emptive transplantation, are being discussed. Using a multidisciplinary integrated care approach predialysis care has come of age.

Key Words: chronic kidney disease • predialysis • pre-emptive transplantation

Received for publication March 6, 2008. Accepted for publication July 1, 2008.


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