The optimal timing of initiation of maintenance dialysis in patients with end-stage renal disease remains in the domain of the art. This transition period is characterized by an exceptionally high risk for adverse patient outcomes. The latest research showed no significant difference in survival or other patient centered outcome for early initiation of dialysis based on estimated glomerular filtration rate (eGFR). These data have challenged the established guideline, including Taiwan's, of using eGFR as the primary guide for initiation of maintenance dialysis and the need for further research to optimized this critical time period.