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