А я теперь понимаю, что СКФ-это всего лишь -цифра, всё определяет -не цифра, а состояние человека, у меня у дочери при скф-25-уже была рвота и головные системные боли , а кто то и при 15 чувствует себя нормально .....

●Asymptomatic patients with eGFR 5 to 15 mL/min/1.73 m2 – We closely follow such patients (eg, monthly) for the emergence of ESRD-related signs and symptoms but do not initiate dialysis in the absence of signs or symptoms. (See 'Signs and symptoms' below.)

●Patients with eGFR 5 to 15 mL/min/1.73 m2 with signs or symptoms that could be due to ESRD ─ Among such patients, we exclude other causes of signs and symptoms and try to treat medically (ie, without dialysis), if possible, especially if the eGFR is >10 mL/min/1.73 m2 (see 'Signs and symptoms' below). We initiate dialysis for those patients whose signs and symptoms are refractory to medical therapy. An important exception is patients who have absolute indications for dialysis, including uremic pericarditis or pleuritis or uremic encephalopathy; such patients should be started on dialysis without delay. (See 'Absolute indications' below.)

As the eGFR declines below 10 mL/min/1.73 m2, patients often develop symptoms of ESRD that no longer can be treated medically and require dialysis [3].

●Patients with eGFR <5 mL/min/1.73 m2 – We and most other nephrologists initiate dialysis for most patients (who plan to do so) when eGFR is ≤5 mL/min/1.73 m2, regardless of the absence or presence of ESRD-related signs or symptoms. At such a markedly reduced eGFR, most patients will have signs and symptoms, which are difficult to treat medically. Furthermore, we believe that, at this eGFR, the risks of the patient requiring emergent dialysis initiation or having severe complications of ESRD are unacceptably high without elective dialysis initiation.

Полностью согласен с рекомендациями,особенно что касается бессимптомных пациентов,действительно от 5 до 15мл/мин,надо следить ежемесячно и не иницировать диализ,при отсутствии признаков или симптомов.Тут конечно требуется оговорка,как мне кажется при перечисленных симптомах,и если значительная анемия,а также:

●Declining nutritional status

●Persistent or difficult to treat volume overload

●Fatigue and malaise

●Mild cognitive impairment

●Refractory acidosis, hyperkalemia, and hyperphosphatemia

These indications are discussed individually below:

●Declining nutritional status – We generally initiate dialysis in patients with an eGFR <15 mL/min/1.73 m2 who have anorexia, weight loss, or poor caloric intake that is not adequately treated by conservative measures. Anorexia, nausea, and weight loss are the most common reasons to initiate dialysis.

With declining eGFR, symptoms of anorexia and weight loss are usually the first uremic symptoms to appear. Loss of appetite for meat is a frequent early symptom and sign [11-14]. In a study of 90 patients with CKD who received no dietary intervention, a direct correlation was noted between the dietary protein intake and the creatinine clearance [12]:

начальником обсуждаемой Садовской, является главный нефролог Петербурга Земченков Александр Юрьевич

Это весь список работ Садовской Д. С.

Земченков А.Ю. безусловный авторитет