Acute hemodialysis prescription
- Phillip Ramos, MD, MSCI
Phillip Ramos, MD, MSCI
- Nephrologist, Denver Nephology, PC
- Denver, Colorado
- Mark R Marshall, MD
Mark R Marshall, MD
- Senior Lecturer in Medicine
- University of Auckland, Faculty of Medicine and Health Sciences
- Middlemore Hospital, New Zealand
- Thomas A Golper, MD
Thomas A Golper, MD
- Section Editor — Dialysis
- Professor of Medicine
- Vanderbilt University Medical Center
- Section Editors
- Jeffrey S Berns, MD
Jeffrey S Berns, MD
- Section Editor — Dialysis
- Professor of Medicine
- Perelman School of Medicine at the University of Pennsylvania
- Paul M Palevsky, MD
Paul M Palevsky, MD
- Section Editor — Renal Failure
- Professor of Medicine
- University of Pittsburgh
- VA Pittsburgh Healthcare System
- Richard H Sterns, MD
Richard H Sterns, MD
- Section Editor — Fluid and Electrolytes
- Professor of Medicine
- University of Rochester School of Medicine and Dentistry
Acute kidney injury (AKI), formerly called acute renal failure (ARF), is a major cause of morbidity and mortality, particularly in the hospital setting. Despite improvements in renal replacement therapy (RRT) during the last several decades, the mortality rate associated with AKI in critically ill patients remains high. (See "Renal and patient outcomes after acute tubular necrosis".)
Acute RRT is commonly indicated for patients with AKI. Available modalities for acute RRT include peritoneal dialysis, intermittent hemodialysis and variations of intermittent hemodialysis (such as hemofiltration), and continuous renal replacement therapy (CRRT).
This topic reviews the acute hemodialysis prescription for patients with AKI. The indications for acute dialysis and the choice of dialysis modality are discussed separately. (See "Renal replacement therapy (dialysis) in acute kidney injury (acute renal failure) in adults: Indications, timing, and dialysis dose", section on 'Indications for and timing of initiation of dialysis' and "Renal replacement therapy (dialysis) in acute kidney injury (acute renal failure) in adults: Indications, timing, and dialysis dose", section on 'Optimal modality' and "Continuous renal replacement therapy in acute kidney injury (acute renal failure)" and "Use of peritoneal dialysis for the treatment of acute kidney injury (acute renal failure)".)
The optimal vascular access for hemodialysis is discussed elsewhere. (See "Overview of central catheters for acute and chronic hemodialysis access".)
COMPONENTS OF THE ACUTE HEMODIALYSIS PRESCRIPTION
The components of the acute dialysis prescription include the choice of hemodialysis membrane, dialysate composition and temperature, blood flow rate, amount and rate of ultrafiltration (UF), choice of anticoagulation, and total dialysis dose.
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- COMPONENTS OF THE ACUTE HEMODIALYSIS PRESCRIPTION
- HEMODIALYZER MEMBRANES
- DIALYSATE COMPOSITION
- - Patients with potassium <4.0 mEq/L
- - Patients with potassium between 4.0 and 5.5 mEq/L
- - Patients with potassium between 5.5 and 8.0 mEq/L
- - Patients with potassium >8.0 mEq/L
- - Efficiency of potassium removal
- - Arrhythmias associated with potassium removal
- - Patients with normal serum sodium
- - Patients with dysnatremias
- Acute dysnatremia
- Severe chronic hyponatremia
- Severe chronic hypernatremia
- Buffer solutions
- BLOOD FLOW RATE
- Determining goal
- Ultrafiltration-related hypotension
- PRE- AND POST-HEMODIALYSIS LABORATORY VALUE MONITORING
- DIALYSIS DOSE
- MANAGEMENT DURING RECOVERY OF RENAL FUNCTION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS