Dialysis - Starting Indications

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":
    1. Acidemia from metabolic acidosis in situations in which correction with sodium bicarbonate is impractical or may result in fluid overload
    2. Electrolyte abnormality, such as severe hyperkalemia, especially when combined with AKI
    3. 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
    4. Overload of fluid not expected to respond to treatment with diuretics
    5. Uremia complications, such as pericarditis, encephalopathy, or gastrointestinal bleeding.
  • Chronic indications for dialysis:
    1. Symptomatic renal failure
    2. 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.
    3. Difficulty in medically controlling fluid overload, serum potassium, and/or serum phosphorus when the GFR is very low

Read more about this topic:  Dialysis

Famous quotes containing the words starting and/or indications:

    “The conviction that the best way to prepare children for a harsh, rapidly changing world is to introduce formal instruction at an early age is wrong. There is simply no evidence to support it, and considerable evidence against it. Starting children early academically has not worked in the past and is not working now.”
    —David Elkind (20th century)

    “You must labour to acquire that great and uncommon talent of hating with good breeding, and loving with prudence; to make no quarrel irreconcilable by silly and unnecessary indications of anger; and no friendship dangerous, in care it breaks, by a wanton, indiscreet, and unreserved confidence.”
    —Philip Dormer Stanhope, 4th Earl Chesterfield (1694–1773)