Timing the initiation of dialysis

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Absolute indications for renal replacement therapy include intravascular volume overload unresponsive to diuretics, hyperkalemia, acidemia, and uremic symptoms (encephalopathy, pericarditis, bleeding diathesis). Although there is no consensus on the ideal timing to initiate dialysis in acute renal failure, it is generally accepted that treatment is initiated when a reversible component to the renal insufficiency has been excluded and well before the occurrence of complications or uremic symptoms. Failure of other organs, rate of increase of urea and creatinine, anticipated catabolism, and urine output should be taken into account. Benefits of early dialysis have to be weighed against the effect of dialysis on residual renal function.

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