At what GFR level should dialysis start?
GFR <10 ml/min. Or ..
- Stage 5 CKD (kidney failure)
- Blood creatinine > 500 mcmol/L.
That’s the short answer. It’s a bit more complicated [“how did I guess you would say that?” CKDEx Ed].
It’s not just the numbers above that lead to a decision to start dialysis. We combine them with your symptoms, and other factors (size, muscle mass etc).
Dialysis should be started for the following reasons.
- If you are unwell – with symptoms or complications of advanced CKD including two danger signs:
- Shortness of breath – due to fluid overload causing pulmonary oedema (water in lungs)
- High blood potassium – persistently > 6 mmol/L
- Blood tests – if you have reached Stage 5 CKD, or have a GFR of <10 ml/min, or a creatinine > 500 mcmol/L – whatever the symptoms
Note. This is a general rule only. There are different levels for different people based on age, gender, ethnicity, and muscle mass - Other factors – that need to be taken into account are:
– Too much acid in the blood (shown by a blood bicarbonate of < 15 mmol/L)
– Unable to control BP
– Not eating, sleeping or other non-specific symptoms. - High-risk patients – e.g. with diabetes or heart failure – may be started earlier.
Note 1. Dialysis should always be started before the GFR has fallen to 5 ml/min, even if optimal pre-dialysis care has not been provided and there are no symptoms
Note 2. To ensure that dialysis is started before the GFR is 5 ml/min, doctors should aim to start you by a GFR of >10 ml/min.
Summary
At what GFR level should dialysis start? It’s not just the numbers above that lead to a decision to start dialysis. We combine them with your symptoms, and other factors (size, muscle mass etc). We hope its been helpful.
Other resource
When to start dialysis? (longer article, with debate on whether its better to start earlier or later)
Last Reviewed on 24 June 2024