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Dialysis is indicated in renal failure when there is a buildup of toxins and waste products in the blood that the kidneys can no longer filter adequately. Stupor or coma suggests severe metabolic derangement, often due to the accumulation of uremic toxins, such as urea and creatinine, which can lead to altered mental status. This is a critical condition that necessitates the use of dialysis to correct electrolyte imbalances, remove toxins, and restore proper physiological function.

In contrast, while elevated white blood cell count could indicate an infection, which may require treatment, it is not a direct indication for dialysis. Hypertension may occur in renal failure but is typically managed with medications rather than dialysis unless it is resistant and associated with fluid overload. Hypotension can complicate certain scenarios in patients with renal failure but does not serve as a primary reason for initiating dialysis. Therefore, the presence of stupor or coma is the clearest and most urgent indication for initiating dialysis to prevent further metabolic and neurological compromise.