Abstract: SA-PO1110
A Global Comparison of Dialysis Initiation Guidelines Across 11 Countries and 6 Continents
Session Information
- Kidney Replacement Therapy and Care Delivery Innovations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Hirani, Chetna N., Trinity Health Oakland Hospital, Pontiac, Michigan, United States
- Patil, Dhrumil, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Bhatt, Parjanya K., Trinity Health Oakland Hospital, Pontiac, Michigan, United States
- Muneeb, Muhammad, Trinity Health Oakland Hospital, Pontiac, Michigan, United States
- Hanna, James, Trinity Health Oakland Hospital, Pontiac, Michigan, United States
- Shah, Priyansh, New York City Health and Hospitals Jacobi, New York, New York, United States
Background
When to initiate dialysis is among the most consequential decisions in nephrology. Prior trials have established no survival benefit of early eGFR-driven over symptom-guided initiation, yet global translation into national guidelines remains uncharacterized. We compared initiation guidelines across three domains: eGFR and symptom-based criteria, conservative kidney management (CKM) recognition, and shared decision-making (SDM).
Methods
Structured narrative review of guidelines published 2015–2025. Where absent, ISN-affiliated documents served as proxies. Guidelines were classified as KDIGO-concordant, partially concordant, or absent.
Results
eGFR thresholds ranged from <2 mL/min (Japan, asymptomatic) to <15 mL/min (Canada/UK, symptomatic), a 13-point spread. Most clustered around 5–10 mL/min, concordant with KDIGO 2024. Symptom criteria were universal but heterogeneous: Western guidelines emphasized fluid overload, serositis, and malnutrition; Asian guidelines additionally incorporated body weight and metabolic parameters. CKM and SDM were formally recognized in 10/11 guidelines; Japan and Indonesia partially compliant. No guideline was identified for Ghana; initiation is resource-driven. Overall, 8/11 were KDIGO-concordant, 2 partially concordant, and 1 absent.
Conclusion
Broad KDIGO concordance exists across high- and middle-income countries, yet variation persists in eGFR thresholds, symptom criteria, and CKM formalization. Japan's threshold of <2 mL/min and Indonesia's partial SDM adoption reflect how structural factors shape guidelines even where KDIGO is nominally referenced. The absence of formal guidelines in Sub-Saharan Africa leaves initiation infrastructure-driven, identifying CKM formalization and low-income settings as priority targets for global nephrology advocacy.