Nephrology Care and Dialysis Management

Chronic kidney disease (CKD) affects an estimated 10% of adults worldwide and poses considerable clinical and economic burdens. Nephrology care spans the spectrum from early risk assessment and management of metabolic and cardiovascular complications to structured preparation for renal replacement therapy. Dialysis management involves a multidisciplinary approach to modality selection—haemodialysis or peritoneal dialysis—creation and maintenance of durable vascular or peritoneal access, symptom control and psychosocial support. Timely referral to nephrologists, patient education programmes and coordinated predialysis pathways are pivotal in reducing emergency starts and improving survival. Innovations in care delivery, such as telemedicine monitoring and integrated registry systems, further enable personalised treatment and continuous quality improvement across diverse healthcare settings.

Research from Nature Portfolio

Recent studies have shown that well planned dialysis initiation with permanent vascular access significantly improves early survival outcomes for patients with end-stage kidney disease. In a large prospective cohort, those commencing planned haemodialysis exhibited lower mortality during the first two years compared with unplanned starts, due largely to reduced infection-related deaths. The benefit was most pronounced in haemodialysis rather than peritoneal dialysis, underscoring the importance of timely access creation and modality maintenance for patient prognosis.

Nephrology Care and Dialysis Management publication trend

The graph below shows the total number of articles in nephrology care and dialysis management across all publications each year (not limited to Nature Index journals).

Technical terms

Chronic kidney disease (CKD): A progressive loss of renal function classified into stages 1–5 based on estimated glomerular filtration rate.

End-stage kidney disease (ESKD): The final stage of CKD (stage 5), necessitating renal replacement therapy such as dialysis or transplantation.

Haemodialysis (HD): A dialysis modality in which blood is filtered through an external machine to remove waste products and excess fluid.

Peritoneal dialysis (PD): A home-based modality that uses the peritoneum as a natural filter through instillation of dialysis fluid into the abdominal cavity.

Vascular access: A surgically created entry point to the bloodstream—commonly an arteriovenous fistula or graft—enabling efficient haemodialysis.

Planned dialysis: Dialysis initiation preceded by preparation, including permanent access creation, modality education and care coordination.

Emergency dialysis initiation: Urgent commencement of dialysis, often via central venous catheter, associated with higher morbidity and mortality.

References

1. Referral, monitoring, and factors associated with non-referral of chronic kidney disease in Germany: a nationwide, retrospective cohort study. The Lancet Regional Health - Europe (2024).
2. The benefit of planned dialysis to early survival on hemodialysis versus peritoneal dialysis: a nationwide prospective multicenter study in Korea. Scientific Reports (2023).
3. Linking disease registries and nationwide healthcare administrative databases: the French renal epidemiology and information network (REIN) insight. BMC Nephrology (2020).
4. Predialysis Care Trajectories of Patients With ESKD Starting Dialysis in Emergency in France. Kidney International Reports (2020).