usually starts before the kidneys completely shut down.
Renal function (GFR) is measured on a scale of 60 to 0, and dialysis usually starts around a level of 15-10. For successful dialysis early planning is important. The shunt (vascular access) needs to be put in at least 6 months before intended use. Most affected persons should see a nephrologist by time their GFR is in the 30-20 range.