When should maintenance dialysis be initiated?

The present trend towared the use of maintenance dialysis in earlier stages of chronic renal failure, and more frequently in association with other morbid illness, raises the question of how well we understand the natural history and prognosis of chronic renal failure prior to total loss of renal function. Survival after serum creatinine exceeds 10 mg/dl is not necessarily very brief and is influenced by many variables. Morbidity and rehabilitation are poorly defined terms that should be approached as objectively and quantitatively as possible if the benefits of dialysis are to be assessed meaningfully.