Renal Replacement Therapy

Renal Replacement Therapy – Joseph Quintana, David Li, Taylor Riggs

Indications for Acute Renal Replacement Therapy [AEIOU]

  • Acidosis: intractable severe pH <7.1 and hypervolemia
    • Unless acidemia quickly reversible like DKA
  • Electrolytes: K, Na, Ca, Phos, Uric acid which are unable to correct by noninvasive or temporizing measures
    • Hyperkalemia: >6.5 mEq/L, cardiac changes, warrant urgent dialysis; Temporize them until dialysis (insulin D5/D50, IV calcium, albuterol, potassium binders)
  • Intoxication: methanol, ethylene glycol, Lithium, ASA
  • Overload: fluid overload, particularly hypervolemia and pulmonary edema, and particularly with renal failure (AKI or ESRD)
    • Try IV Lasix challenge 240 mg IV (if >200 mL in 2 hrs urine, then no need for dialysis);
      • Can discuss sequential nephron blockade with nephrology
    • If anuric w/o pulmonary edema: nephrology will give things 24 hours to settle out
  • Uremia: pericarditis, seizure, functional platelet dysfunction in advance of a pending procedure, or decline in mental status

 

ESRD Admits

  • Consult ESRD in the morning for routine dialysis unless more urgently needed
  • Routine orders include MWF phos checks and Renal diet
  • For peritoneal dialysis pts, their diet can be more liberal and include low phos only or even regular diet (Can just ask what diet he/she follows at home)