When to start dialysis treatment : Where do we stand?

Since the publication of opinion-based guidelines regarding the timing of dialysis treatment, there has been a trend toward earlier initiation. In this review, the existing guidelines and the currently published studies that evaluate them are discussed. These studies could not demonstrate a clear benefit on survival or quality of life for patients who started with relatively higher renal function. 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.