Dialysis in AKI: When to start?

When should we start dialysis in a patient with acute kidney injury?

Jürgen Floege, MD: Same indications as with chronic kidney injury: (1) When you have life-threatening hyperkalemia that you cannot get under control; (2) when you have metabolic acidosis that cannot be controlled; (3) when you are unable to remove fluid from your patient with diuretics or any other means and your patient is overhydrated or even close to pulmonary edema; (4) or—and that is where it becomes vague—when patients have any evidence of uremia.

Of course, I am stressing this is vague and very subjective judgement, but when I have an acutely confused patient with a pretty high urea level, 200 mg/dL or so, if in doubt, I would rather do a dialysis.