My fiancee has pkd and is at 20% gfr. how will we know when it's time to go to the hospital and start dialysis, etc.?

Regular visits: You need to regularly see your family doctor or nephrologist, either of whom can order bloodwork to follow his serum creatinine. If it is over 4.0, most nephrologists will want to start dialysis. Presuming that he is not at that level, now is the time for him to see a surgeon to have an arterio-venous fistula placed to make hemodialysis easier to perform.

IT DEPENDS: Usually dialysis is considered if GFR<10.However several factors are considered before starting dialysis. Kidney doc will monitor the blood tests closely and suggest dialysis based on lab results/Most often patient don;t feel anything until kidney function is less than 15%. Common symptoms- tiredness, leg swelling, poor appetite, shortness of breath, itching, poor sleep, abnormal taste in the mout