Renal replacement therapy (dialysis) in acute kidney injury (acute renal failure): Recovery of renal function and effect of hemodialysis membrane
- 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 may be required in patients with severe acute renal failure. Mortality in such patients is often associated with infection or bleeding. Since these problems can be exacerbated by uremia, it has been suggested that dialysis begun before evidence of overt uremia may lead to improved survival. This issue is complicated by evidence that dialysis may delay the recovery of renal function.
This topic will review concerns related to whether dialysis delays the recovery of renal function as well as the effects of different hemodialysis membranes. An overview of supportive management in acute kidney injury is also presented.
The indications for and optimal timing and dose of dialysis in acute renal failure as well as the metabolic and hemodynamic changes associated with dialysis in acute renal failure 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".)
Before discussing dialysis in acute renal failure, an overview of general issues in nondialytic management of patients with established acute renal failure is indicated. The basic goals for the management of established acute renal failure are the maintenance of fluid and electrolyte balance, avoidance of nephrotoxic medications, adequate nutrition, treatment of infections, correction of reversible prerenal (eg, hypovolemia) and postrenal factors, close monitoring, and proper dosing of medications .
Hyperkalemia and fluid overload are more likely to occur in oliguric patients. Problems with hyperkalemia can be minimized by restriction of potassium intake, avoidance of potassium-containing and sparing drugs, and appropriate treatment of hyperkalemia. Although hyperkalemia and metabolic acidosis can initially be treated medically, dialysis is usually required to adequately manage these abnormalities in patients with acute renal failure. (See "Clinical manifestations of hyperkalemia in adults" and "Treatment and prevention of hyperkalemia in adults" and 'Indications for dialysis' below.)
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- SUPPORTIVE MANAGEMENT
- CAN DIALYSIS DELAY RECOVERY OF RENAL FUNCTION?
- Fall in urine output
- Repeated episodes of hypotension
- Complement activation, membrane biocompatibility, renal recovery, and survival
- INDICATIONS FOR DIALYSIS
- DIALYSIS DOSE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS