Canadian Guidelines Recommend an “Intent-to-Defer” Approach to Dialysis

New Canadian Society of Nephrology guidelines published in CMAJ recommend that nephrologists closely monitor patients with an eGFR <15 mL/min/1.73 m², and that dialysis does not need to start until a patient’s eGFR drops to 6 mL/min/1.73 m² or has clinical worsening. This should allow patients to avoid the burden of earlier dialysis initiation when clinical indications are not present, while avoiding complications of uremia. The recommendation is based on a review of 23 studies, including the IDEAL trial, which found that early initiation did not improve survival, quality of life, or hospital admission rates compared with deferred initiation.