Dialysis
In medicine, renal dialysis is a method for removing waste such
as urea from the blood when the kidneys are incapable of this (i.e.
in renal failure).
In acute renal failure, (renal) dialysis is generally
initiated when the renal function has deteriorated to an extent
that it is threatening the body's physiology. Volume overload (i.e.
hypervolemia) that is unresponsive to strong diuretics, such as
furosemide, and severe hyperkalemia are two common indications for
dialysis.
In chronic renal failure the problem is usually longstanding,
and the decision is based on the possibility of a renal transplant,
complications of the malfunctioning kidney (e.g. hyperkalemia, uremia)
and personal factors (such as tiredness due to the uremia). Chronic
renal failure that does not have an acute (i.e. reversible) component
and requires dialysis is called end-stage renal disease (ESRD).
There is no general agreement among nephrologists on when to start
dialysis. In Canada some nephrologists advocate that patients with
CRF should start dialysis when the GFR is below 15 mL/min and below
20 mL/min for patients with diabetes mellitus. Canadian guidelines
suggest considering dialysis when the GFR is less than 12 mL/min
In the United States, dialyisis is initated at a GFR of 15 mL/min
in diabetics and 10mL/min in non-diabetics, in conjuction with uremic
sypmtoms. Most guidelines agree that dialysis should be started
before the GFR drops below 6 mL/min. The rationale for starting
dialysis early is it prevents illness associated with severe uremia
and may minimize long-term complications associated with kidney
failure. Studies have shown that starting dialysis with a lower
GFR is associated with a poor nutritional status which is associated
with a higher mortality in the first two years of treatment.
Acute renal failure can present on top of (i.e. in
addition to) chronic renal failure. This is called acute-on-chronic
renal failure (AoCRF) and may require dialysis temporarily (until
the acute component of the renal failure resolves).
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