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Indications for initiation of dialysis in chronic kidney disease

Anthony Bleyer, MD, MS
Section Editors
Steve J Schwab, MD
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD


For patients with chronic kidney disease (CKD), the decision of when to start chronic dialysis is a difficult one that is made in collaboration between the nephrologist and patient. The decision is difficult because, although dialysis effectively treats the signs and symptoms of uremia and fluid overload (some of which may be life threatening), it is a lifelong therapy that is associated with discomfort, inconvenience, and some risk for the patient.

As a result, dialysis should be started when the benefit from relieving uremic signs and symptoms is thought to outweigh its risk and associated effect on quality of life, but not before this time.

Preparation for dialysis is integrated into the overall care of the patient with advanced CKD. Ideally, the decision to initiate dialysis is made long after consideration of the patient for kidney transplantation and after the patient has already chosen his or her dialysis modality and has an appropriate, functioning access in place.

This topic reviews the indications for chronic dialysis for patients with end-stage renal disease (ESRD). Other issues related to the care of the CKD patient and to options of renal replacement therapy are discussed elsewhere. (See "Overview of the management of chronic kidney disease in adults" and "Choosing a modality for chronic peritoneal dialysis".)

The indications for acute dialysis are discussed elsewhere. (See "Renal replacement therapy (dialysis) in acute kidney injury in adults: Indications, timing, and dialysis dose", section on 'Urgent indications'.)

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Literature review current through: Nov 2017. | This topic last updated: Dec 06, 2017.
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