Indications for acute dialysis are life-threatening complications of acute kidney injury that fail to respond to medical management.
These are best remembered by the classic AEIOU mnemonic: Acidosis, Electrolyte imbalances, Intoxications, Overload, and Uraemia.
1. Acidosis
Severe, refractory metabolic acidosis, typically when the blood pH is \(<7.1\) or \(7.2\) despite treatment.
2. Electrolyte Imbalances
Life-threatening abnormalities—most commonly severe hyperkalemia (potassium \(> 6.5 \text{ mEq/L}\)) or rapid increases with EKG changes (e.g., peaked T-waves) that do not respond to medical therapy.
3. Intoxications (Toxins)
Acute overdose or poisoning by dialyzable substances. Common examples include alcohols (methanol, ethylene glycol), lithium, salicylates, and certain medications.
4. Overload
Severe volume overload, most notoriously acute pulmonary edema (fluid in the lungs) that is unresponsive to high-dose diuretics.
5. Uraemia:
Neurological or systemic complications of toxin buildup in the blood. This includes uremic encephalopathy (confusion, seizures), uremic pericarditis (inflammation of the heart lining), or uremic bleeding.
Deciding when to start is highly patient-specific and typically determined by a nephrologist or critical care team. For further context on medical triage, diagnostic thresholds, and the difference between continuous or intermittent therapies
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