Heaf J, Heiro M, Petersons A, et al. - Whether there exists a link between suboptimal dialysis initiation (SDI) and pre-dialysis care, was investigated. Participants were 1,583 end-stage kidney disease patients initiating dialysis over a 3-year span at 15 nephrology departments in the Nordic and Baltic countries, examined in the ‘Peridialysis’ study in order to explore factors related to SDI. Findings revealed the occurrence of SDI in 42% of all dialysis initiations. Late referral, cachexia, comorbidity (especially cardiovascular), hypoalbuminaemia and rapid uraemia progression were all identified as risk factors for SDI. A lower incidence of SDI was observed in patients with polycystic renal disease. The identified markers of SDI, independently of estimated glomerular filtration rate (eGFR), were: high urea and C-reactive protein levels, acidosis and other electrolyte disorders. Experts identified a link of SDI with hypoalbuminaemia, comorbidity as well as with rate of eGFR loss, but not with the degree of renal failure as evaluated by eGFR.