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End-stage renal disease (ESRD) is when kidney function is no longer adequate for long-term survival without kidney transplantation or dialysis.1,2 The estimated glomerular filtration rate (GFR) is usually less than 15 mL per minute per 1.73 m2 when this occurs.3 Kidney failure, a more concise term, may soon replace ESRD.4
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| Refer people at increased risk of ESRD to nephrology (see Table 1 for indications).3,8 | B | Cohort studies showing reduced mortality |
| Shared decision-making should be used when considering dialysis for patients with ESRD, including educating patients about the various dialysis modalities and the option of conservative management.3 | C | Expert opinion and consensus guidelines, in the absence of clinical trials |
| To preserve peripheral venous access in patients with stage III to V chronic kidney disease, avoid excessive venipuncture, peripherally inserted venous catheters, and subclavian venous catheters.17 | C | Expert opinion and consensus guidelines, in the absence of clinical trials |
| Avoid routine cancer screening for most patients with ESRD who are not candidates for kidney transplantation.17 | C | Expert opinion and consensus guidelines, in the absence of clinical trials |
| Insulin is preferred for most patients with ESRD who have diabetes mellitus that requires medication.37 | C | Expert opinion and consensus guidelines, in the absence of clinical trials |
ESRD = end-stage renal disease.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to
BEST PRACTICES IN NEPHROLOGY
Recommendations from the Choosing Wisely Campaign
| Recommendation | Sponsoring organization |
|---|---|
| Do not perform routine cancer screening in asymptomatic patients receiving dialysis if they have a limited life expectancy. | American Society of Nephrology |
| Do not place peripherally inserted central catheters in patients with stage III to V chronic kidney disease without consulting nephrology. | American Society of Nephrology |
| Do not initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their physicians. | American Society of Nephrology |
Source: For more information on the Choosing Wisely Campaign, see
The incidence of ESRD increased more than...