Dialysis Indications

A 52-year-old man with type 2 diabetes mellitus and hypertension presents to the nephrology clinic with progressive renal dysfunction. His current investigations show: serum creatinine 8.2 mg/dL, blood urea nitrogen 92 mg/dL, potassium 6.8 mEq/L, bicarbonate 16 mEq/L, and phosphate 7.2 mg/dL. Urinalysis shows 3+ proteinuria. His blood pressure is 168/104 mmHg. He denies any symptoms of uremia. Which of the following is the most appropriate next step in management?

A 38-year-old woman with IgA nephropathy presents to the emergency department with severe dyspnea, orthopnea, and bilateral ankle edema. Examination reveals bibasilar crackles, elevated JVP, and a third heart sound. Laboratory investigations show: serum creatinine 6.8 mg/dL, potassium 7.2 mEq/L, bicarbonate 14 mEq/L, and BUN 110 mg/dL. Chest X-ray shows bilateral pulmonary edema. Urine output over the past 24 hours is 200 mL. What is the most appropriate immediate management?