What are the key indications for initiating haemodialysis in patients with chronic kidney disease?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025Updated: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Key indications for initiating haemodialysis in patients with chronic kidney disease (CKD) include:

  • Presence of symptoms of uraemia that significantly impact daily living.
  • Uncontrollable fluid overload despite medical management.
  • Biochemical abnormalities indicative of kidney failure, such as a very low estimated glomerular filtration rate (eGFR) around 5 to 7 ml/min/1.73 m if there are no symptoms.

The decision to start haemodialysis should be made jointly by the patient (or their family/carers) and the healthcare team, ensuring that symptoms are not caused by non-renal conditions before initiating dialysis.

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