Initiating chronic dialysis
Preparing for kidney failure, the indications for starting dialysis, why timing follows symptoms rather than an eGFR number (IDEAL), and when conservative kidney management is the better choice.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Dialysis is started for symptoms and complications of kidney failure that medical treatment can't control, not at a fixed eGFR.
- IDEAL (NEJM 2010) showed no benefit from starting early. Most patients now start with eGFR between 5 and 10 mL/min/1.73 m².
- Planning should start about a year ahead: education, modality choice, access, transplant work-up and the option of conservative kidney management.
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Sources
- Chronic Kidney Disease (CKD) Management in Primary Care, 5th editionAU/NZKidney Health Australia, 2024 (current edition, checked November 2026)
- Cooper BA et al. A randomized, controlled trial of early versus late initiation of dialysis (IDEAL). N Engl J Med 2010;363:609-19New England Journal of Medicine, 2010
- Chan CT et al. Dialysis initiation, modality choice, access, and prescription: conclusions from a KDIGO Controversies Conference. Kidney Int 2019;96(1):37-47Kidney Disease Improving Global Outcomes, 2019 (a conference report, not a guideline; no current initiation guideline found, November 2026)
- Nesrallah GE et al. Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis. CMAJ 2014;186(2):112-7Canadian Medical Association Journal, 2014
- KDIGO 2026 Clinical Practice Guideline for the Management of Anemia in Chronic Kidney Disease. Kidney Int 2026;109(1S):S1-S99Kidney Disease Improving Global Outcomes, 2026 (replaces the 2012 guideline)
- KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney DiseaseKidney Disease Improving Global Outcomes, 2024
- Lok CE et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis 2020;75(4 Suppl 2):S1-S164National Kidney Foundation KDOQI, 2019
- Davison SN et al. Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease. Kidney Int 2015;88:447-59Kidney Disease Improving Global Outcomes, 2015
- Australian Immunisation Handbook, hepatitis B chapterAU/NZAustralian Government Department of Health, Disability and Ageing
- ANZDATA Registry 48th Annual Report 2025 (data to 31 December 2024), chapters 1 (incidence), 3 (mortality) and 10 (First Nations Australians)AU/NZAustralia and New Zealand Dialysis and Transplant Registry, 2025
- Last updated
- 14 November 2026
What changed
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