Indications of dialysis in acute renal failure (ARF)

• Severe fluid overload
• Refractory hypertension
• Uncontrollable hyperkalemia
• Nausea, vomiting, poor appetite, gastritis with hemorrhage
• Lethargy, malaise, somnolence, stupor, coma, delirium, asterixis, tremor, seizures,
• Pericarditis (risk of hemorrhage or tamponade)
• bleeding diathesis (epistaxis, gastrointestinal (GI) bleeding and etc.)
• Severe metabolic acidosis
• Blood urea nitrogen (BUN) > 70 – 100 mg/dl

 
Indications of dialysis in chronic renal failure (CRF)

• Pericarditis
• Fluid overload or pulmonary edema refractory to diuretics
• Accelerated hypertension poorly responsive to antihypertensives
• Progressive uremic encephalopathy or neuropathy such as confusion, asterixis, myoclonus, wrist or foot drop, seizures
• Bleeding diathesis attributable to uremia

References:

1. Hemodialysis Adequacy 2006 Work Group. KDOQI Clinical Practice Guidelines for Hemodialysis Adequacy, Update 2006. Am J Kidney Dis 2006; 48(Suppl 1):S2-90.[Medline]
2. Pannu N, Klarenbach S, Wiebe N, Manns B, Tonelli M; Alberta Kidney Disease
   Network. Renal replacement therapy in patients with acute renal failure: a systematic
   review. JAMA. 2008 Feb 20;299(7):793-805.[Medline]

 Created:Jun 19, 2009