This is not an easy question, I still rely on patients trajectory, clinical judgement.

I never rely on any one thing to decide on when to refer for access placement. Their current level of kidney function, the trajectory, whether it is due to an underlying disease (lupus, diabetes, heart failure) that is or is not under good control, and of course, whether they want to do hemodialysis...

eGFR alone is not enough to decide when to refer patients for vascular access placement. What we really want to know is the time about 6 months before patient needs dialysis. That information is more often dependent on how fast the renal function is worsening rather than the absolute eGFR. I don't n...