Starting Indications
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 summarized with the vowel acronym of "AEIOU":
- Acidemia from metabolic acidosis in situations in which 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 dialyzable substance. These substances can be represented by the mnemonic SLIME: salicylic acid, lithium, isopropanol, Magnesium-containing laxatives, and ethylene glycol
- Overload of fluid not expected to respond to treatment with diuretics
- Uremia complications, 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
Read more about this topic: Dialysis
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