When uremia develops to a certain stage and excessive metabolites accumulate in the body, which affects daily life and even threatens life, dialysis treatment should be started. In general, dialysis treatment should be started when serum creatinine is above 707 μmol/L, or serum urea nitrogen is close to 30 mmol/L, or blood potassium is >6.5 mmol/L. However, even if the serum creatinine, urea nitrogen or potassium does not reach these levels, if the patient is combined with severe uremic symptoms (nausea, vomiting, edema, etc.), or with serious comorbidities such as metabolic acidosis or hyperparathyroidism that are difficult to correct, or with heart failure, dialysis treatment should be started as early as possible. On the other hand, even if the serum creatinine or urea nitrogen exceeds the above levels, if the patient does not have obvious symptoms of uremia or serious comorbidities such as heart failure or uremic encephalopathy, non-dialysis treatment can be continued. Patients with blood potassium greater than 6.5 mmol/L do not need to start dialysis treatment immediately if their blood potassium can be reduced to less than 5.5 mmol/L with general medical treatment. Early initiation of dialysis treatment is good for protecting the function of organs other than the kidneys in patients with uremia, but it is not good for protecting the function of the residual kidneys and brings about an increase in medical costs. So, when is the best time to start dialysis treatment? Generally speaking, if the combination of diabetes, hypertension or elderly patients, patients with poor function of organs other than kidneys or the presence of various uremic comorbidities are more serious, dialysis treatment should be started as early as possible without waiting for serum creatinine or urea nitrogen to reach the above criteria before starting dialysis treatment, otherwise it will affect the long-term survival of patients after dialysis. In contrast, if the patient’s renal function deteriorates slowly, with good dietary control, non-significant uremic symptoms, stable blood pressure control, no obvious cardiovascular complications, and anemia and hyperparathyroidism that can be controlled by medication, non-dialysis treatment can be continued and there is no need to start dialysis urgently. Therefore, there is no absolute standard for when to start dialysis treatment, and it should be recommended by the clinician based on the patient’s individual situation and decided together with the patient and family.