Nephrology Cases #6: Clinical Outcomes of Chronic Kidney Disease (In Order Of Preference)

Chronic kidney disease sometimes follows a progressive course that ends in transplantation, dialysis, or death. Many outcomes are possible, and nephrologists try to ensure the best ones for their patients. In decreasing order of preference, the range of outcomes for patients with chronic kidney disease may include:

1. Stable kidney function, usually through blood pressure control and the use of medications. Dialysis or transplantation is never needed.
2. Kidney transplantation.
3. Hemodialysis with a native arteriovenous fistula, which should be created and allowed to mature months before dialysis is needed. Some patients choose (and prefer) peritoneal dialysis instead.
4. Hemodialysis with a synthetic graft, which is easier to place then a fistula, can be used sooner, but has a higher rate of complications.
5. Hemodialysis with a tunneled dialysis catheter, which is not desirable for long term access because it has a high rate of complications, particularly infections.
6. Urgent hemodialysis with a temporary (nontunneled) catheter.
7. Unanticipated death due to untreated kidney failure.

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