Uremic Syndrome: Systemic Manifestations and Current Criteria for Dialytic Therapy Initiation.

Abstract

Introduction: Uremic syndrome is interpreted as a systemic condition caused by the retention of uremic solutes and the loss of excretory and regulatory functions in advanced chronic kidney disease. Objective: To describe the systemic manifestations of uremic syndrome and summarize the current criteria for initiating dialytic therapy. Methodology: A scoping review was conducted on PubMed/MEDLINE using MeSH searches and free text on uremia, uremic toxins, systemic manifestations, and "dialysis initiation," excluding hemolytic uremic syndrome. The period considered was 2016–2025, including guidelines, consensus documents, reviews, and observational studies in humans; the selection was made based on title/abstract and full text, with standardized extraction and thematic synthesis. Results: Nineteen high-quality publications were included. The evidence agreed that the initiation of dialysis should not be defined by an isolated eGFR threshold but by uremic symptoms and refractory complications, such as volume overload, functional impairment, neurological manifestations, severe itching, and pericarditis, among others. In older adults, starting dialysis was associated with modest survival gains and reduced "home time," supporting shared decisions based on care goals and individual preferences. Conclusion: Uremic syndrome is better approached as a syndromic and person-centered framework; dialytic therapy is indicated when the symptomatic burden or complications are clinically significant and uncontrollable with medical treatment.