The decision to initiate dialysis or hemofiltration in patients with renal failure depends on several factors. These can be divided into acute or chronic indications.
Indications for dialysis in the patient with acute kidney injury are summarized with the vowel acronym of "AEIOU":
Acidemia from metabolic acidosis in situations in which correction with sodium bicarbonate is impractical or may result in fluid overload.
Electrolyte abnormality, such as severe hyperkalemia, especially when combined with AKI.
Intoxication, that is, acute poisoning with a dialyzable substance. These substances can be represented by the mnemonic SLIME: salicylic acid, lithium, isopropanol, magnesium-containing laxatives, and ethylene glycol.
Overload of fluid not expected to respond to treatment with diuretics
Uremia complications, such as pericarditis, encephalopathy, or gastrointestinal bleeding.
Indications for chronic dialysis: Chronic dialysis may be indicated when a patients has symptomatic renal failure and low glomerular filtration rate (GFR). Between 1996 to 2008 there was a trend to initiate dialysis at progressively higher estimated GFR, eGFR. A review of the evidence shows no benefit or potential harm with early dialysis initiation, which has been defined by start of dialysis at an estimated GFR of greater than 10ml/min/1.732.Observational data from large registries of dialysis patients suggests that early start of dialysis may be harmful. The most recent published guidelines from Canada, for when to initiate dialysis, recommend an intent to defer dialysis until a patient has definite renal failure symptoms, which may occur at an estimated GFR of 5-9ml/min/1.732.
Some reason for dialysis initiation include difficulty in medically controlling fluid overload or serum potassium. If a patient has intractable renal failure symptoms or signs, start of dialysis may be recommended at e GFR levels above 10ml/min/1.732