Inclusion Criteria:  Age > 17 years Both gender CKD stage 5 with clinical or biochemical criteria to kidney replacement therapy initiation that includes: Urea nitrogen > 80 mg/dl Hyperkalemia Fluid overload Metabolic acidosis (ph < 7.2 and/or bicarbonate <12)  Exclusion Criteria:  Visual disturbances Altered mental status at enrollment Hypothyroidism without optimal supplementation Advanced neoplasia Acute kidney injury