The decision to initiate dialysis in a patient with chronic kidney disease (CKD) involves the consideration of subjective and objective parameters by the physician and the patient. There are no absolute laboratory values that indicate a requirement to begin dialysis. The decision is partly based on the patient’s perception of his or her quality of life and anxiety about starting a complex, potentially lifelong therapy. In addition, the nephrologist’s perception about the patient’s state of health, decline of kidney function, and potential hazards of therapy influence the timing of initiation of renal replacement therapy. In short, the decision of when to start dialysis is clearly one of the most difficult decisions that both the patient and the nephrologist must make.
This topic reviews the clinical indications for the initiation of chronic dialysis.
The selection of dialysis modality is discussed separately (see "Dialysis modality and patient outcome" and "Choosing a modality for chronic peritoneal dialysis"). Considerations regarding transplantation are also discussed separately. (See "Evaluation of the potential renal transplant recipient" and "Patient survival after renal transplantation".)
There are a number of clinical indications to initiate dialysis in patients with CKD. These include [1-3]:
●Pericarditis or pleuritis (urgent indication)
●Progressive uremic encephalopathy or neuropathy, with signs such as confusion, asterixis, myoclonus, wrist or foot drop, or, in severe cases, seizures (urgent indication)