<s>[INST] my creatin is 3.8.in october 2011 it was 2.9.my current gfr is 16. kindly advise whethewr I should get A.V. fistyula is to be done at present and what level of creatine an gfr i need dialysis.please let me know at this stage any other medication can help to avoid dialysis. i am diabetic and have B.P.for about 10 years  which is under controlR.Shah Newyork Usa [/INST] Dear Shah, It is very important to have preemptive AVF at this stage, though you might not require dialysis in near future. It is best to have good glycemic control and blood pressure control which can postpone your dialysis. The only way to ovoid dialysis is kidney Transplant. There is no specified creatinine level at which dialysis is initiated, its the symptoms like breathing difficulty, loss of appetite and persistent nausea/vomiting which decide initiation of dialysis in patients having </s>