The influence of treatment methods on the timing of dialysis commencement in persons with simultaneous chronic cardiovascular disease and advanced chronic kidney disease (CKD) was not well understood. About 777 patients with advanced CKD and moderate or severe ischemia were randomized to choose an initial invasive or conservative therapy plan in ISCHEMIACKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches–Chronic Kidney Disease). Researchers evaluated the proportion of randomized patients with non–dialysis–requiring CKD at baseline (n=362) who started dialysis and the time to start dialysis between the invasive and conservative therapy arms in the study. Researchers also used multivariable Cox regression analysis to determine if invasive versus conservative chronic coronary disease care regimens had an influence on dialysis initiation. Dialysis was started in 18.9% of invasive approach participants (36/190) and 16.9% of conservative strategy participants (29/172) at a median follow-up of 23 months (25th–75th interquartile range, 14–32 months) (P=0.22). The invasive group’s median time to dialysis commencement was 6.0 months (interquartile range, 3.0–16.0 months), and the conservative groups were 18.2 months (interquartile range, 12.2–25.0 months) (P=0.004), with no difference in procedural acute kidney injury rates (7.8% versus 5.4%; P=0.26). Lower baseline estimated glomerular filtration rate (HR, 2.08 [95% CI, 1.72–2.56]; P<0.001), diabetes (HR, 2.30 [95% CI, 1.28–4.13]; P=0.005), hypertension (HR, 7.97 [95% CI, 1.09–58.21]; P=0.041), and Hispanic ethnicity (HR, 2.34 [95% CI, 1.22–4.47]; P=0.010) were all associated with 5‐unit decrease. Randomization to an invasive chronic coronary disease management approach (vs a conservative chronic coronary disease management strategy) was related to a faster time to initiation of maintenance dialysis for kidney failure in ISCHEMIACKD patients with non–dialysis–requiring CKD.