Dialysis is not initiated based on a single creatinine or urea number. It is a clinical decision driven by complications of advanced kidney failure: refractory fluid overload (dyspnea/edema), dangerous hyperkalemia, severe acidosis, uremic symptoms (nausea, anorexia, confusion), or pericarditis. Some patients develop symptoms at higher eGFR than others. Therefore, “creatinine X means dialysis” is an oversimplification. The goal is coordinated nephrology follow-up and timely preparation (vascular access planning, education, nutrition) based on symptoms, labs, and overall stability. Suspected rapid deterioration requires urgent evaluation.