Dialysis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Dialysis Main Page
Patient Information
Overview
Classification Hemodialysis Peritoneal Dialysis
Indications

Overview

Chronic kidney disease (CKD) prevalence has an incremental pattern worldwide due to increased rate of diabetes mellitus and hypertension as the leading causes of CKD, increasing life expectancy, and aging of the populations. On the other hand, acute kidney injury requires renal replacement therapy in certain circumstances. Dialysis is an intervention aiming to substitutes for solutes and removing extra fluids to help or substitute the failing kidneys. It is considered as a renal replacement therapy method which is indicated in certain condition depending on severity and chronicity of the underlying condition. In acute setting, refractory increased electrolytes and fluid overload are the most common indications for dialysis. eGFR is the determining factor to initiate dialysis in chronic kidney disease however, uremic symptoms are important to consider early versus late dialysis based on eGFR.

Starting indications

The decision to initiate dialysis or hemofiltration in patients with renal failure can depend on several factors, which can be divided into acute or chronic indications.

• Acute Indications for Dialysis/Hemofiltration:
  • 1) Hyperkalemia
  • 2) Metabolic Acidosis
  • 3) Fluid overload (which usually manifests as pulmonary oedema)
  • 4) Uremic pericarditis, a potentially life threatening complication of renal failure
  • 5) And in patients without renal failure, acute poisoning with a dialysable drug, such as lithium, or aspirin.
• 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)
  • 3) Difficulty in medically controlling serum phosphorus or anaemia when the GFR is very low

References

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