Most of the time, chronic kidney disease (CKD) has no symptoms until a great deal of kidney function has been lost. The most common symptoms of advanced CKD are fluid retention and swelling in the feet and legs, nausea, especially in the mornings or with eating protein. Weight loss is a late sign of advanced CKD. The fluid retention can lead to shortness of breath and difficulty lying flat in bed. The blood pressure may be very high in patients with advanced CKD. These are some of the symptoms of advanced CKD, but the decision to perform dialysis or transplantation is based on an examination and recommendation by a nephrologist. This evaluation must be performed by the nephrologist and then a discussion must be undertaken by the patient and the nephrologist about the risks and the benefits of dialysis and transplantation.