Table 1.

Adapted from the European Renal Best Practice advisory board 2011 updated position statement on initiation of Dialysis.(57)

Recommendation	Evidence
Dialysis preparation in patients with advanced CKD should include preparing for dialysis, kidney transplant or conservative care before their CKD becomes symptomatic. This process, including advanced preparation of appropriate access, careful observation for signs and symptoms of uremia, should be started while eGFR is >15 mL/min/1.73m2. Supervision in a dedicated clinic for advanced CKD patients is recommended.	Strong recommendation based on low-quality evidence
Dialysis initiation in patients with eGFR <15 mL/min/1.73m2 should be considered when there are signs/symptoms of uremia, inability to control hydration status or blood pressure and/or a progressive deterioration in nutritional status. It should be noted that the majority of patients will become symptomatic and require dialysis as eGFR falls to 9–6 mL/min/1.73m2.	Strong recommendation based on high-quality evidence
High-risk patients such as those with diabetes and renal function deteriorating more rapidly than 4 mL/min/year require particularly close supervision. In patients whose uremic symptoms may be difficult to detect and/or close supervision is not feasible a planned start to dialysis while still asymptomatic may be preferred.	Strong recommendation based on low-quality evidence
Asymptomatic patients presenting with advanced CKD may benefit from a delay in starting dialysis in order to allow preparation, planning and permanent access creation rather than using temporary access.	Weak recommendation based on low-quality evidence

Chronic kidney disease – CKD; estimated glomerular filtration rate - eGFR