Which is an indication for renal replacement therapy in CKD?

• A. End-stage renal disease with symptoms
• B. GFR 22 with no symptoms
• C. GFR 60
• D. Rapid progression with no symptoms

Answer: (A)

Indications for renal replacement therapy come from symptoms and complications of kidney failure, not just the measured kidney function. When the kidneys fail to maintain homeostasis and the patient develops uremic symptoms or trouble with fluid, electrolyte, or acid-base balance that cannot be controlled with medical therapy, dialysis is indicated.

End-stage renal disease with symptoms is the clear scenario for starting dialysis because there are tangible uremic manifestations or metabolic derangements driving the need for external toxin and fluid removal. In contrast, having a GFR around 22 with no symptoms means the kidneys are reduced in function, but there are no active uremic symptoms to mandate dialysis at that moment. A GFR of 60 is not advanced kidney failure, so it does not indicate RRT. Rapid progression without symptoms suggests worsening risk, but without symptoms or complications, dialysis isn’t immediately required; it signals the need for close monitoring and planning if symptoms develop.