manage and refer as per NICE guidance on chronic kidney disease disease in adults
starting dialysis should be considered when indicated by the impact of symptoms of uraemia on daily living, or biochemical measures or uncontrollable fluid overload, or at an estimated glomerular filtration rate (eGFR) of around 5 to 7 ml/min/1.73m2 if there are no symptoms
the decision to start dialysis is made jointly by the person (or, where appropriate, their family members or carers) and their healthcare team
before starting dialysis in response to symptoms
be aware that some symptoms may be caused by non-renal conditions
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