Even though significant progress has been attained in the question of dialysis therapy--experts have not addressed the aspect of when is proper moment to initiate dialysis therapy. It has not been proven that early starting of hemodialysis with higher GFRvalues has positive influence on decreasing mortality in this patients population. Steady rise in the number of elderly patients with multiple comorbidities qualified for hemodialysis results in increased mortality in this group. Aside from the continuing discussion pertaining to dialysis therapy initiation authors have attempted to answer the question: "Does qualification and initiation of maintenance hemodialysis treatment permanently close the aspect of resignation from therapy due to clinical improvement?". The study consisted of 140 subjects treated by maintenance hemodialysis in the Dialysis Unit Department of Nephrology, University Hospital, in Cracow, during the years between 2009-2012. Among 63 patients with initiated hemodialysis during this period--5 patients resigned from therapy due to clinical improvement. These were elderly patients between the ages of 74-88 years with chronic renal disease probably due to ischemic and/or diabetic nephropathy exacerbated by hypotension, dehydration, myocardial infarct or administration of contrast materials.
Conclusions: Initiation of maintenance hemodialysis therapy according to actual standards does not exclude the possibility in resignation from dialysis treatment due to clinical improvement, especially in the elderly patients group. Enormously significant during this period is precise clinical patient evaluation in the subject of volemia, which in turn protects the patient from excess ultrafiltration that in turn eliminates residual diuresis.