Patients with stage 5 chronic kidney disease (glomerular filtration rate [GRF] <15 mL/min/1.73 m2 or receiving dialysis) often develop signs of uremia and require kidney replacement therapy. Absolute indications include uncontrollable hyperkalemia, uncontrollable hypervolemia, altered mental status or excess somnolence, pericarditis, or bleeding-diathesis secondary to uremic platelet dysfunction. Relative indications include nausea, vomiting, and poor nutrition caused by decreased appetite; severe metabolic acidosis; mild changes in mental status such as lethargy and malaise; asterixis; and worsening of kidney function with GFR less than 15 mL/min/1.73 m2. However, the timing of hemodialysis in patients without fluid overload, hyperkalemia, metabolic acidosis, or uremic symptoms, such as this patient, is unclear. A recent study suggests early initiation of hemodialysis does not improve patient outcomes. Kidney transplantation is the treatment of choice for uremia. Transplantation in patients who have not yet been treated with hemodialysis is associated with better patient and allograft outcomes. This patient has several family members who are willing kidney donors, and it is possible that he could receive a transplant in the near future; therefore, the best course of action would be to follow the patient closely to ensure he does not develop uremic signs or symptoms or other indications for dialysis and strive for transplantation rather than dialysis.