Unifying Concepts

Indications of Dialysis in Renal Failure

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, 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



  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

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