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For health professionals

When is the right moment to start dialysis in order to improve patient survival and quality of life? Is the estimated GFR a suitable parameter for determining when dialysis is imperative? In what way should nephrologists take into account which uraemic symptoms? How do patients weigh the different factors in deciding when (and if) dialysis should be initiated?

From the available evidence the level of kidney function at which patient survival and quality of life are improved by starting dialysis remains unknown. The possibility that harm may be done by starting dialysis at higher levels of eGFR cannot be excluded. This calls for a careful evaluation of current dialysis initiation practices.

In a prospective cohort study a large number of renal centres in Germany, Italy, Sweden, The Netherlands and the United Kingdom will include patients ³ 65 years of age whose renal function drops below 20 mL/min/1.73m2 for the first time while being under the care of a nephrologist.

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