Background: Patients with end-stage renal disease (ESRD) receive renal replacement therapy (RRT) to improve their survival and quality of life. Whereas RRT might be life-saving in certain conditions, dialysis also is unphysiologic and may have life-threatening complications. Better understanding of nephrologists' decision making regarding the start of RRT would assist further studies relating residual kidney function and signs and symptoms at the start of dialysis therapy to prognosis. Therefore, the aim of this study was to evaluate current opinions on factors influence the decision of dialysis by performing a survey of nephrologists in Qalubia Governorate, Egypt. Methods: This cross-sectional observational study included nephrologists from different hospitals, in Qalubia, Egypt. This study included a web-based survey using the online tool SurveyMonkey (SurveyMonkey.com). Approval of Ethics Committee in the Faculty of Medicine, Benha University was taken before preceding the study. Results: Our results showed that 84% of studied physicians would recommend dialysis decision patient when eGFR decreased regardless any clinical symptoms or signs out of them 71.4% recommend dialysis if GFR decreased below 10 ml and others 28.6% recommend it when GFR decreased below 15 ml. While only 30% of studied physicians recommend initiation of dialysis if GFR increased especially above 30 ml (60% out of them). Conclusions: That nearly 84% of nephrologists based their decision to initiate dialysis on eGFR alone. Initiatives designed to safely delay dialysis through aggressive medical management could focus on modifiable factors that are the most important drivers of the decision to initiate dialysis.