A large multicenter randomized-controlled multi-level effectiveness-implementation emphasis pragmatic trial to evaluate the comparative effectiveness of early initiation of dialysis with eGFR at 10 mL/min/1.73m2 without clinical signs or symptoms attributed to advanced kidney failure vs. current standard of care of initiating dialysis for eGFR < 10 mL/min/1.73m2 with clinical signs or symptoms attributed to advanced kidney failure.

Inclusion:

- Age: 18-100 y/o

- GFR <= 15

Exclusion:

- On dialysis

- Dead