Dialysis-related factors that may influence recovery of renal function in acute kidney injury (acute renal failure)
- Edward D Siew, MD, MSCI
Edward D Siew, MD, MSCI
- Assistant Professor of Medicine
- Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease (VCKD)
- Vanderbilt University Medical Center
- Thomas A Golper, MD
Thomas A Golper, MD
- Section Editor — Dialysis
- Professor of Medicine
- Vanderbilt University Medical Center
- Section Editors
- Steve J Schwab, MD
Steve J Schwab, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- University of Tennessee Health Science Center
- Paul M Palevsky, MD
Paul M Palevsky, MD
- Section Editor — Renal Failure
- Professor of Medicine
- University of Pittsburgh
- VA Pittsburgh Healthcare System
Dialysis-requiring acute kidney injury (AKI-D) affects a large percentage of hospitalized and, particularly, critically ill patients [1-6]. The incidence is increasing by 10 percent per year and affects approximately 0.4 percent of hospitalized patients and between 3 to 13 percent of critically ill patients [1-6].
The reasons for this growth are not known, though an aging population, broadening array of nephrotoxins, growth in conditions associated with AKI such as sepsis, and a liberalization of thresholds to initiate renal replacement therapy (RRT) are likely contributors [7-10].
Patients who survive AKI-D are at risk for permanent loss of kidney function and poor quality of life [11-16]. Cardiovascular risks and mortality are increased when kidney function does not recover [17,18].
This topic reviews dialysis-related factors that may influence the recovery from AKI-D. Overall outcomes of AKI and patient-related risk factors that may affect recovery of renal function are discussed elsewhere. (See "Renal and patient outcomes after acute tubular necrosis", section on 'Degree of recovery'.)
The indications, prescriptions, dose, and modalities of RRT in AKI are discussed separately. (See "Renal replacement therapy (dialysis) in acute kidney injury in adults: Indications, timing, and dialysis dose" and "Renal replacement therapy (dialysis) in acute kidney injury (acute renal failure): Metabolic and hemodynamic considerations".)
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- DIALYSIS-RELATED FACTORS
- Repeated episodes of hypotension
- Infection risk
- Exposure to nephrotoxic medications
- Method of anticoagulation
- Nutritional factors
- Characteristics of the dialysis membrane
- Timing and dose of dialysis
- FALL IN URINE OUTPUT
- PROTECTING THE KIDNEY FROM FURTHER INJURY
- SUMMARY AND RECOMMENDATIONS