 The timing for initiating dialysis for progressive chronic kidney disease CKD patients is an important issue yet is not well established. There is a strong trend to early dialysis initiation for end stage renal disease ESRD patients over the past decades. However, observational data found that early initiation seemed to produce no benefit but additional burden to patients and the health care system. The IDEAL study, the only randomized, controlled trial RCT on this issue, found that all-cause mortality, comorbidities and quality of life had no difference between early glomerular filtration rate, GFR 10-14mlmin1.73m2 and late GFR 5-7mlmin1.73m2 dialysis starters. However there was a big limitation in this study that the difference for average GFR between two groups 12 mlmin1.73 m2 vs. 9.8 mlmin1.73m2 was not so separate. Recently, the Canadian Society of Nephrology have released a clinical practice guideline on this issue. The guideline recommends an intent-to-defer approach for dialysis initiation and to initiate dialysis in the absence of symptoms in patients with an estimated GFR of 6 mlmin 1.73 m2 or less. In this guideline the specialists also express that the optimal management of patients with an estimated GFR of 6 mlmin per 1.73 m2 or less is based on limited data. There is a gap in knowledge. This research will further evaluate the efficacy and safety of deferred dialysis initiation and fill in this gap. In this study, algorithms will be adopted to determine the timing of dialysis initiation for both routine and deferred dialiysis groups, and the only difference in these two algorithms is the GFR level to initiate dialysis 7 Vs. 5 mlmin per 1.73 m2. The theory that blood access arteriovenous fistulas can be timely prepared according to the past GFR decline trajectory will also be tested. 