Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Christopher T. Chan, Peter J. Blankestijn, Laura M. Dember, Maurizio Gallieni, David C.H. Harris, Charmaine E. Lok, Rajnish Mehrotra, Paul E. Stevens, Angela Yee Moon Wang, Michael Cheung, David C. Wheeler, Wolfgang C. Winkelmayer, Carol A. Pollock, Ali K. Abu-Alfa, Joanne M. Bargman, Anthony J. Bleyer, Edwina A. Brown, Andrew Davenport, Simon J. Davies, Frederic O. FinkelsteinJennifer E. Flythe, Eric Goffin, Thomas A. Golper, Rafael Gómez, Takayuki Hamano, Manfred Hecking, Olof Heimbürger, Barnaby Hole, Daljit K. Hothi, T. Alp Ikizler, Yoshitaka Isaka, Kunitoshi Iseki, Vivekanand Jha, Hideki Kawanishi, Peter G. Kerr, Paul Komenda, Csaba P. Kovesdy, Ed Lacson, Maurice Laville, Jung Pyo Lee, Edgar V. Lerma, Nathan W. Levin, Monika Lichodziejewska-Niemierko, Adrian Liew, Elizabeth Lindley, Robert S. Lockridge, Magdalena Madero, Ziad A. Massy, Linda McCann, Klemens B. Meyer, Rachael L. Morton, Annie Claire Nadeau-Fredette, Hirokazu Okada, Jose Perez, Jeff Perl, Kevan R. Polkinghorne, Miguel C. Riella, Bruce M. Robinson, Michael V. Rocco, Steven J. Rosansky, Joris I. Rotmans, María Fernanda Slon Roblero, Navdeep Tangri, Marcello Tonelli, Allison Tong, Yusuke Tsukamoto, Kriang Tungsanga, Tushar J. Vachharajani, Ismay van Loon, Suzanne Watnick, Daniel E. Weiner, Martin Wilkie, Elena Zakharova

Research output: Contribution to journalArticlepeer-review

203 Scopus citations


Globally, the number of patients undergoing maintenance dialysis is increasing, yet throughout the world there is significant variability in the practice of initiating dialysis. Factors such as availability of resources, reasons for starting dialysis, timing of dialysis initiation, patient education and preparedness, dialysis modality and access, as well as varied “country-specific” factors significantly affect patient experiences and outcomes. As the burden of end-stage kidney disease (ESKD) has increased globally, there has also been a growing recognition of the importance of patient involvement in determining the goals of care and decisions regarding treatment. In January 2018, KDIGO (Kidney Disease: Improving Global Outcomes) convened a Controversies Conference focused on dialysis initiation, including modality choice, access, and prescription. Here we present a summary of the conference discussions, including identified knowledge gaps, areas of controversy, and priorities for research. A major novel theme represented during the conference was the need to move away from a “one-size-fits-all” approach to dialysis and provide more individualized care that incorporates patient goals and preferences while still maintaining best practices for quality and safety. Identifying and including patient-centered goals that can be validated as quality indicators in the context of diverse health care systems to achieve equity of outcomes will require alignment of goals and incentives between patients, providers, regulators, and payers that will vary across health care jurisdictions.

Original languageEnglish (US)
Pages (from-to)37-47
Number of pages11
JournalKidney International
Issue number1
StatePublished - Jul 2019


  • goal-directed dialysis
  • hemodialysis
  • home dialysis
  • initiation
  • modality
  • peritoneal dialysis
  • prescription
  • symptom control
  • vascular and peritoneal dialysis access

ASJC Scopus subject areas

  • Nephrology


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