{"id":1066,"date":"2012-08-01T00:00:16","date_gmt":"2012-08-01T07:00:16","guid":{"rendered":"http:\/\/rhochistj.org\/RhoChiPost\/?p=1066"},"modified":"2014-02-17T22:12:20","modified_gmt":"2014-02-18T05:12:20","slug":"indications-dialysis-mnemonic-explanation","status":"publish","type":"post","link":"https:\/\/rhochistj.org\/RhoChiPost\/indications-dialysis-mnemonic-explanation\/","title":{"rendered":"Indications for Dialysis: A Mnemonic And Explanation"},"content":{"rendered":"<p><span style=\"font-size: 11pt; line-height: 1.5em;\">By: Neal Shah, Co-Editor-in-Chief<\/span><\/p>\n<p><b>&#8211;\u00a0<\/b><\/p>\n<p>Dialysis is the removal of substances from intravascular circulation by filtration.<sup>1<\/sup> \u00a0Typically, dialysis is ordered when kidney function declines to 10\u201315% of normal function.<sup>2<\/sup> \u00a0The National Kidney Foundation&#8217;s Kidney Disease Outcome Quality Initiative (K\/DOQI) recommends that planning for dialysis begin when patients reach chronic kidney disease stage 4, which is when glomerular filtration rate or creatinine clearance reaches below below 30 mL\/min.<sup>3<\/sup> \u00a0However, this is not the only indication for the initiation dialysis. \u00a0A subset of acute and chronic renal failure indications are provided below:<sup>4<\/sup><\/p>\n<p>Indications of dialysis in acute renal failure (ARF)<\/p>\n<ul>\n<li>Severe fluid overload<\/li>\n<li>Refractory hypertension<\/li>\n<li>Uncontrollable hyperkalemia<\/li>\n<li>Nausea, vomiting, poor appetite, gastritis with hemorrhage<\/li>\n<li>Lethargy, malaise, somnolence, stupor, coma, delirium, asterixis, tremor, seizures,<\/li>\n<li>Pericarditis (risk of hemorrhage or tamponade)<\/li>\n<li>bleeding diathesis (epistaxis, gastrointestinal (GI) bleeding and etc.)<\/li>\n<li>Severe metabolic acidosis<\/li>\n<li>Blood urea nitrogen (BUN) &gt; 70\u2013100 mg\/dl<\/li>\n<\/ul>\n<p>Indications of dialysis in chronic renal failure (CRF)<\/p>\n<ul>\n<li>Pericarditis<\/li>\n<li>Fluid overload or pulmonary edema refractory to diuretics<\/li>\n<li>Accelerated hypertension poorly responsive to antihypertensives<\/li>\n<li>Progressive uremic encephalopathy or neuropathy such as confusion, asterixis, myoclonus, wrist or foot drop, seizures<\/li>\n<li>Bleeding diathesis attributable to uremia<\/li>\n<\/ul>\n<p>A simple mnemonic is used to remember the indications for dialysis: A-E-I-O-U.<sup>5<\/sup><\/p>\n<div align=\"center\">\n<table width=\"90%\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td><b>Dialysis: Indications<\/b><\/td>\n<\/tr>\n<tr>\n<td><b>AEIOU<\/b>:<br \/>\n<b>A<\/b>cid-base problems<br \/>\n<b>E<\/b>lectrolyte problems<br \/>\n<b>I<\/b>ntoxications<br \/>\n<b>O<\/b>verload, fluid<br \/>\n<b>U<\/b>remic symptoms<a href=\"file:\/\/\/C:\/Users\/T\/Dropbox\/RhoChiNewsletter%20ARCHIVE\/Draft%20Material%20to%20Review\/Volume%201%20-%20Completed\/Issue%2011%20-%20Aug%20-%20Finalized%20-%207-29-12\/3.%20Incorporated\/Neal%20Rho%20Chi%20Dialysis%20-%20AMC.docx#_msocom_2\"><br \/>\n<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<p>The normal bodily pH averages 7.4.\u00a0 Respiratory centers act to maintain the pH between 7.35 and 7.45 and the kidneys act to remove bicarbonate or ammonium in response to acid-base changes. \u00a0In severe kidney disease, this homeostatic mechanism is disrupted, and the body can rapidly turn acidotic or alkalotic regardless of compensation from the respiratory centers. \u00a0This acid-base problem is an indication for dialysis, where these molecules can be removed and normal pH can be restored.<sup>6<\/sup><\/p>\n<p>The kidneys normally actively secrete potassium from the distal convoluted tubule and loops of Henle. \u00a0When kidney failure or injury sets in, hyperkalemia can easily develop. \u00a0Symptoms of hyperkalemia include fatigue, myalgia, and muscular weakness. \u00a0Severe hyperkalemia can present as tented T-waves on an EKG and progression to ventricular fibrillation. \u00a0Dialysis removes excess potassium from the bloodstream and returns the body back down to physiological levels.<sup>6<\/sup><\/p>\n<p>Overdose and intoxication of substances that are found in the blood may be an indication for dialysis. \u00a0These drugs should have a low volume of distribution and shouldn\u2019t be highly bound to plasma proteins. \u00a0Unfortunately, some common overdose or intoxicant drugs like digoxin and tricyclic antidepressants have volumes of distribution in hundreds of liters, and are not readily removed by dialysis.<sup>6<\/sup> \u00a0Ethanol is easily removed via dialysis, as are some anti retroviral drugs, aminoglycosides, and antibiotics.<sup>7<\/sup><\/p>\n<p>Indications for fluid resuscitation are numerous, ranging from hypovolemia to hypotension.<sup>6<\/sup> \u00a0When patients regain clinically acceptable statuses, the fluids administered are then considered to be fluid overloads, and should be removed to prevent iatrogenic heart failure. \u00a0Dialysis can be used to remove excess fluids from patients\u2019 bodies.<\/p>\n<p>Uremia often develops in chronic kidney failure, brought on by the inability to excrete nitrogenous wastes, parathyroid hormone, proteins and other physiological substances in toxic levels.<sup>8<\/sup> \u00a0Since these substances are floating in the bloodstream, dialysis can easily clear the body of these toxins to restore physiological homeostasis.<\/p>\n<p><b><span style=\"text-decoration: underline;\">SOURCES:<\/span><\/b><\/p>\n<ol>\n<li>Dialysis. Available at: <a href=\"http:\/\/www.nlm.nih.gov\/medlineplus\/dialysis.html,\" target=\"new\" class=\"external external_icon\">http:\/\/www.nlm.nih.gov\/medlineplus\/dialysis.html,<\/a> Accessed August 5, 2012.<\/li>\n<li>Dialysis. Available at: <a href=\"http:\/\/www.kidney.org\/atoz\/content\/dialysisinfo.cfm,\" target=\"new\" class=\"external external_icon\">http:\/\/www.kidney.org\/atoz\/content\/dialysisinfo.cfm,<\/a> Accessed August 5, 2012.<\/li>\n<li>Sowinski KM and Churchwell MD. Pharmacotherapy: A Pathophysiologic Approach, 8th edition. Section 5. Renal Disorders, Chapter 54. Hemodialysis and Peritoneal Dialysis. <a href=\"http:\/\/www.accesspharmacy.com\/content.aspx?aID=7982188,\" target=\"new\" class=\"external external_icon\">http:\/\/www.accesspharmacy.com\/content.aspx?aID=7982188,<\/a> accessed August 5, 2012. 2011 by The McGraw-Hill Companies, Inc. Accessed August 5, 2012.<\/li>\n<li>Firman, G. Indications of Dialysis in Renal Failure. <a href=\"http:\/\/www.medicalcriteria.com\/site\/index.php?option=com_content&#038;view=article&#038;id=245%3Anephdrf&#038;catid=63%3Anephrology&#038;Itemid=80&#038;lang=en,\" target=\"new\" class=\"external external_icon\">http:\/\/www.medicalcriteria.com\/site\/index.php?option=com_content&amp;view=article&amp;id=245%3Anephdrf&amp;catid=63%3Anephrology&amp;Itemid=80&amp;lang=en,<\/a> Accessed August 5, 2012.<\/li>\n<li>Palmer M. Dialysis: Indications. <a href=\"http:\/\/www.medicalmnemonics.com\/cgi-bin\/return_browse.cfm?discipline=Urology%20%2F%20Nephrology&#038;browse=1,\" target=\"new\" class=\"external external_icon\">http:\/\/www.medicalmnemonics.com\/cgi-bin\/return_browse.cfm?discipline=Urology%20%2F%20Nephrology&amp;browse=1,<\/a> Accessed August 5, 2012.<\/li>\n<li>Fauci A, Kasper D, Longo D, et al. Harrison&#8217;s Principles Of Internal Medicine, 17th edition. Chaper 48. Acidosis and Alkalosis. 2008, The McGraw-Hill Companies, Inc. Accessed August 5, 2012.<\/li>\n<li>Bailie, GR and Mason, NA. 2012 Dialysis of Drugs. Renal Pharmacy Consultants, LLC. Saline, Michigan.<\/li>\n<li>Alpner, AB. Uremia. <a href=\"http:\/\/emedicine.medscape.com\/article\/245296-overview#a0101,\" target=\"new\" class=\"external external_icon\">http:\/\/emedicine.medscape.com\/article\/245296-overview#a0101,<\/a> Accessed August 5, 2012.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>By: Neal Shah, Co-Editor-in-Chief &#8211;\u00a0 Dialysis is the removal of substances from intravascular circulation by filtration.1 \u00a0Typically, dialysis is ordered when kidney function declines to 10\u201315% of normal function.2 \u00a0The National Kidney Foundation&#8217;s Kidney Disease Outcome Quality Initiative (K\/DOQI) recommends that planning for dialysis begin when patients reach chronic kidney disease stage 4, which is&hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7,4],"tags":[668,343,98,22,66,15,2229,2227,29,2296,2257,314,39,133,2253,2235,166,725,363,1625,11,167,256,184,55,1736,36,2252,1061],"class_list":["post-1066","post","type-post","status-publish","format-standard","hentry","category-clinical","category-featured","tag-acid","tag-and","tag-august","tag-blood","tag-dialysis","tag-disease","tag-drugs","tag-ebola-virus-disease","tag-editor","tag-encephalopathy","tag-fibrillation","tag-for","tag-heart","tag-hemorrhage","tag-hypertension","tag-kidney","tag-malaise","tag-mg","tag-of","tag-or","tag-pharmacy","tag-poor","tag-potassium","tag-problem","tag-renal","tag-respiratory","tag-risk","tag-symptoms","tag-with"],"views":220203,"_links":{"self":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts\/1066","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/comments?post=1066"}],"version-history":[{"count":0,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts\/1066\/revisions"}],"wp:attachment":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/media?parent=1066"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/categories?post=1066"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/tags?post=1066"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}