Dialysis Dialysis is usually initiated at the onset of either of the following: Uremic symptoms (eg, anorexia, nausea, vomiting, weight loss, pericarditis, pleuritis) Difficulty controlling fluid overload, hyperkalemia, or acidosis with drugs and lifestyle interventions These problems typically occur when the estimated GFR reaches ≤ 10 mL / min in a patient without diabetes or ≤ 15 mL / min in a patient with diabetes; patients whose estimated GFR values are near these values should be closely monitored so that these signs and symptoms are recognized early.