At which stage of renal failure should dialysis be started?

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Abstract
The issue of the adequate or optimal time at which renal replacement therapy (RRT) should be initiated for patients with advanced or terminal chronic renal failure (CRF) has been a matter of debate since the very first introduction of this revolutionary therapeutic concept, now close to 40 years ago, and is not yet settled. The lack of means of treatment, due mainly to economic constraints, continues to play a key role in many areas of the world for retarding (or denying) RRT for a great number of patients with CRF. However the issue remains controversial in countries with good availability of therapeutic facilities, due either to inadequate medical management of many patients prior to the ultimate stage of renal insufficiency or to conceptual/academic conflicts between different lines of thought set forward by defendants of `early dialysis' versus challengers advocating the advantages and safety of dietary restrictions for delaying to a significant extent the initiation of dialysis treatment.

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