I had a fistula placed 3 months ago. My vascular surgeon says it is mature and ready to be used. How will I know when I need to start hemodialysis?

You will be closely monitored by your nephrologist. Your nephrologist looks for any symptoms of renal failure, such as nausea or vomiting, increased sleepiness, difficulty concentrating, or twitching. Your nephrologist will assess your fluid status. Are you retaining fluid in your legs or lungs? Are you short of breath or having chest pain? Your nephrologist will review your blood work to be sure your kidneys are adequately maintaining your electrolytes and filtering toxins from your blood. Most patients need to start renal replacement therapy when they reach CKD stage 5. Some patients need to start renal replacement therapy at earlier stages depending on their symptoms, fluid status, and blood work.