The decision to initiate dialysis or hemofiltration in patients with renal failure depends on several factors. These can be divided into acute or chronic indications.
- Indications for dialysis in the patient with acute kidney injury are:
- Metabolic acidosis in situations where correction with sodium bicarbonate is impractical or may result in fluid overload.
- Electrolyte abnormality, such as severe hyperkalemia, especially when combined with AKI.
- Intoxication, that is, acute poisoning with a dialysable drug, such as lithium, or aspirin.
- Fluid overload not expected to respond to treatment with diuretics.
- Complications of uremia, such as pericarditis, encephalopathy, or gastrointestinal bleeding.
- Chronic indications for dialysis:
- Symptomatic renal failure
- Low glomerular filtration rate (GFR) (RRT often recommended to commence at a GFR of less than 10-15 mls/min/1.73m2). In diabetics dialysis is started earlier.
- Difficulty in medically controlling fluid overload, serum potassium, and/or serum phosphorus when the GFR is very low
Further Reading
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