Renal Replacement Therapy in Critical Care

      
       

 

          
       

Why would one need to dialyze a patient? 

The kidneys excrete waste products, control total body water and aspects of acid base balance. Renal failure occurs when the kidney is not capable of fulfilling it's obligations. In essence renal replacement therapy is required to either prevent endogenous poisoning or fluid overload. It is important to remember that urinary output does not represent renal function: the kidney may be able to filter fluid, but not to clear metabolic waste.

The most commonly cited clinical indications for renal replacement therapy are:

  • Fluid overload
  • Severe hypertension
  • Hyperkalemia
  • Metabolic Acidosis
  • Uremia
     
 

Indications for starting dialysis:
 

Oliguria (urine output <200 mL/12 h)

Anuria/extreme oliguria (urine output <50 mL/12 h)

Hyperkalemia ([K] >6.5 mEq/L)

Severe acidemia (pH <7.1)

Azotemia ([urea] >30 mg/dL)

Clinically significant organ (especially pulmonary) edema

Uremic encephalopathy

Uremic pericarditis

Uremic neuropathy/myopathy

Severe dysnatremia ([Na] <115 or >160 mEq/L)

Hyperthermia

Drug overdose with dialyzable toxin

 

          
                   
       

         
     

       
       

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