When the patient needs dialysis?
Typically, dialysis is ordered when the kidney function declines to 10-15% of its normal function. As per NKF KDOQI, planning for dialysis should begin when patients reach chronic kidney disease stage 4/ CKD 4, it is when the glomerular filtration or creatinine clearance falls below 30mL/min.
However, this is not the only indication for the initiation of dialysis treatment. There are lots of them. Here is an easier way to know the indication for a dialysis treatment. The A-E-I-O-U of dialysis.
A. Acidosis – metabolic acidosis with a pH <7.1
E. Electrolytes – refractory hyperkalemia with a serum potassium >6.5 mEq/L or rapidly rising potassium levels.
I. Intoxications – use the mnemonic SLIME to remember the drugs and toxins that can be removed with dialysis: salicylates, lithium, isopropanol, methanol, ethylene glycol.
O. Overload – volume overload refractory to diuresis (Fluid Overload)
U. Uremia – elevated BUN with signs or symptoms of uremia, including pericarditis, neuropathy, uremic bleeding, or an otherwise unexplained decline in mental status (uremic encephalopathy).