🩺 When to Start Dialysis
Understanding early vs late initiation and clinical indicators for starting renal replacement therapy.
📋 Two Options to Start Dialysis
1️⃣ Early start dialysis
Start dialysis therapy as soon as eGFR reaches 10‑14 mL/min, even without severe symptoms.
2️⃣ Late start dialysis
Postpone dialysis until eGFR drops to 5‑7 mL/min or until uraemic symptoms develop.
📊 Evidence note: There is no proven advantage of one option over the other regarding mortality. The decision should be individualised based on symptoms, quality of life, and patient preference.
🚨 Indications for Early Starting Dialysis
Early dialysis is generally recommended if any of the following are present (especially when eGFR < 10‑14 mL/min):
- Hyperkalemia with symptoms (muscle weakness, ECG changes)
- Hypervolemia / fluid overload (oedema, pulmonary congestion)
- Dyspnea, difficulty in breathing due to fluid overload
- Overwhelming fatigue (inability to perform daily activities)
- Generalised skin itching (pruritus)
- Loss of appetite, nausea, vomiting
- Frequent hospital admissions for kidney‑related issues
- Unexpected weight loss (protein‑energy wasting)
- Skin discoloration and urine‑like body odour
- Shortness of breath, chest pain, irregular pulse
- Confusion and loss of consciousness (uraemic encephalopathy)
- Metallic taste in the mouth
- Feeling faint or dizzy
- Trouble with mental focus / concentration
- Feeling cold when others are warm
⚠️ If you experience any of these symptoms, discuss with your nephrologist – starting dialysis may improve quality of life and prevent complications.
📌 Key Takeaway
The “right” time to start dialysis varies by person. Some people feel better with an earlier start, while others prefer to delay. The most important factors are symptoms, nutritional status, fluid balance, and electrolyte control – not the eGFR number alone.
Discuss your personal goals and concerns with your nephrology team to make an informed decision.