Austin and Repatriation Medical Center Indications for Initiating Dialysis of a Patient in the Intensive Care Unit

 

Therapeutic options:

(1) intermittent hemodialysis

(2) peritoneal dialysis

(3) continuous hemofiltration

 

Declining renal function:

(1) decreased urine output (oliguria with 24 hour urine output < 500 mL; anuria with 12 hour urine output < 50 mL)

(2) serum creatinine > 4.5 mg/dL (> 400 µmol/L)

(3) BUN > 84 mg/dL (urea > 30 mmol/L)

 

Metabolic problems:

(1) hyperkalemia (> 6 mmol/L and rising)

(2) pulmonary edema despite maximal diuresis

(3) severe metabolic acidosis (pH < 7.1, base deficit > 10 mmol/L)

 

Uremic complications:

(1) uremic encephalopathy

(2) uremic pericarditis

(3) uremic neuropathy

 

In addition some toxin exposures may be treated by hemodialysis.