Did you mean indications related an initiation of dialysis for acute kidney injury (AKI) ?
Not just AKI, even AKI on CKD, or Just CKD missing Dialysis or any other
Hi, since you are preparing for Critical Care masters thesis, I am going to assume you mean in the ICU, in the AKI (acute kidney injury) setting. Indications for acute dialysis: All indications are relative, and that have already failed medical management (ex: reasonable dose diuretics, base supplements, etc) or medical management is contraindicated (ex: kayexelate not option for high potassium, anuric so diuretics not useful, etc) There is no absolute Blood urea nitrogen , creatinine, or cystatin C level that is a true indication for dialysis (although there will be debate about starting when BUN rises above 100 mg/dl as uremic effects may be seen more likely, see below)
Volume overload
Metabolic acidosis (lactate generated faster THANan it can be removed in some forms of lactic acidosis)
Electrolyte derangements(most often Hyperkalemia, but could be hypercalcemia, hyperuricemia in tumor lysis to prevent AKI or with AKI, other)
Hyperammonemia (inborn error of metabolism while awaiting
Intoxication by dialyzable drug or agent (most often NOT highly protein bound, other factors also affect, but databases for ability to remove drugs and toxins by different forms of dialysis available; methanol ingestion, lithium, antifreez)
Uremia: degree of AKI that interferes with physiologic functions (ex: BUN high enough that pt develops pericardial effusion, platelet function decreased, mental status changes, are examples.)
In pediatrics, dialysis/ some for of renal replacement therapy is indicated in AKI in order to provide nutritional support that would be impossible due to necessary fluid restriction imposed to avoid volume overload. We tend to want to start renal replacement therapy earlier rather than later to AVOID complications. Great papers on mortality associated with volume overload in pediatric patients by Stuart Goldstein et al, as an example in AKI setting
CKD many of the same issues cause start of dialysis therapy (chronic) , in addition to failure to thrive, fatigue , other "uremic symptoms" before the classic indication of creatinine clearance less than 10 ml/min/1.73m2 (some target 15 ml/min/1.73m2) as absolute indication. This is pediatrics, US-style units, but many indications are universal for adults and children/infants
I'm sure other responders will add to this list! Hope this is helpful to you
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