When to start dialysis treatment: Where do we stand?

Background. Since the publication of opinion-based guidelines regarding the timing of dialysis treatment, there has been a trend toward earlier initiation. Objective: In this review, the existing guidelines and the currently published studies that evaluate them are discussed. Results: These studies could not demonstrate a clear benefit on survival or quality of life for patients who started with relatively higher renal function. Conclusion: Early start of dialysis treatment should not be confused with early referral to the nephrologist. It is concluded that initiation of dialysis should not depend on a predefined magnitude of renal function, but should be tailored to the individual patient.