5 Indications for Starting Hemodialysis

The decision to start dialysis is generally based on the patient's symptoms, level of kidney function, and fluid status.

Intractable hyperkalemia, metabolic acidoses, fluid overload, uremia and a low GFR are indications for hemodialysis

1. Intractable hyperkalemia

Intractable hyperkalemia is a condition characterized by excessively high levels of potassium in the blood. This can be a life-threatening condition, as high levels of potassium can cause heart arrhythmias and even cardiac arrest. Chronic kidney disease (CKD) patients are particularly susceptible to developing hyperkalemia, as their kidneys are not able to effectively remove potassium from the blood. Dialysis is the most common treatment for hyperkalemia, but in some cases, medications or dietary changes may be necessary.

2. Intractable metabolic acidosis

Intractable metabolic acidosis in chronic kidney disease is a serious condition that can lead to a number of health problems. Metabolic acidosis occurs when there is an imbalance in the body's acid-base levels. This can happen when the kidneys are not able to remove enough acid from the blood. Chronic kidney disease can lead to metabolic acidosis because the kidneys are not able to function properly. When this happens, the body's acid-base levels can become imbalanced, which can lead to a number of health problems.

3. Intractable fluid overload

Intractable fluid overload in chronic kidney disease (CKD) is a condition in which the excess fluid in the body cannot be removed by the kidneys. This can lead to a number of serious health problems, including heart failure, stroke, and death.

4. Uremic symptoms

The most common uremic symptoms of CKD are fatigue, trouble sleeping, and general malaise. Other symptoms can include nausea, vomiting, loss of appetite, weight loss, itching, and muscle cramps.

As the disease progresses, patients may experience more serious symptoms such as high blood pressure, anemia, fluid buildup in the body, and kidney failure. Patients with CKD often need to make lifestyle changes to help manage their symptoms. This can include eating a healthy diet, maintaining a healthy weight, exercising regularly, and avoiding alcohol and tobacco. In some cases, patients may also need to take medication to control their symptoms.

5. GFR <15 ml/min/m2

There are a number of ways to estimate glomerular filtration rate (GFR). The most common method is to use the Cockcroft-Gault equation. Other methods of estimating GFR include the Modification of Diet in Renal Disease (MDRD) Study equation and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.

A low glomerular filtration rate (GFR) indicates that the kidneys are not functioning properly. A GFR below 15 mL/min/1.73 m2 is considered to be kidney failure and warrants hemodialysis or peritoneal dialysis.

‍