Early Versus Late Initiation of Dialysis and Nutrition: Does a Transition Mean a Change in Dietary Protein Intake?

Over the last 15 to 20 years, there has been an increasing trend toward early initiation of dialysis in patients with chronic kidney disease (CKD). This was based on early retrospective studies suggesting better clinical outcomes with an early start of dialysis, resulting in guidelines advocating an early start of dialysis in stage 5 CKD patients. However, this clinical practice came into question when more recent observational cohort studies reported higher mortality rates among CKD patients who started dialysis early. In this article, we review the current controversies relating to the timing of initiation of dialysis in patients with advanced CKD. More importantly, we provide a discussion on whether the transition between early and late initiation of dialysis treatment may mean a change in dietary protein intake prescription in patients with advanced CKD.