Indications for dialysis in acute renal failure

The article is professionally consulted by Specialist Doctor I Nguyen Hung - Department of Medical Examination & Internal Medicine - Vinmec Danang International General Hospital.

Acute kidney failure is a condition in which kidney function suddenly decreases, this is a very fast-growing disease, which is life-threatening if the patient is not treated promptly. The indications for dialysis in acute renal failure with the development of hemodialysis by hemodialysis have increased the likelihood of treatment success and patient survival.

1.1 What is acute renal failure? Acute renal failure is an acute, temporary failure and loss of function of both kidneys due to the cessation or rapid decline in glomerular filtration rate. There are many causes that can lead to acute renal failure, these causes can be extrarenal or renal causes. Clinical manifestations of acute renal failure are oliguria, acute anuria, increased non-protein nitrogen in the blood, electrolyte disturbances, acid-base disturbances, edema, hypertension,... This is a dangerous disease, Acute kidney disease has a high risk of death, but with timely diagnosis and treatment, kidney function can be completely restored.
1.2 Causes of acute kidney failure Based on the pathogenesis of acute kidney failure, the causes of acute kidney failure can be divided into the following groups:
Prerenal causes Include all causes of decreased blood flow to the kidney, causing renal failure. reduce glomerular pressure and cause oliguria, anuria such as hypovolemic shock, septic shock, cardiogenic shock, hypersensitivity shock, decreased colloidal pressure in nephrotic syndrome, decompensated cirrhosis,...
Raw Renal causes Including physical damage to the kidney, seen in kidney diseases such as: rapidly progressive glomerulonephritis, acute glomerulonephritis after streptococcal infection, infectious interstitial nephritis, renal vasculitis in diseases Systemic blood vessels, post-ischemic renal necrosis, nephrotoxicity, malignant hypertension,...
Post-renal causes Includes causes of renal urinary tract obstruction such as urinary tract stones, blood clots clot, tumor, urethral obstruction, prostate enlargement, prostate cancer,...

Treatment of acute renal failure follows the following general principles:
If possible, determine the cause of acute renal failure and prompt treatment to eliminate the cause Correction of circulatory disorders, maintaining blood pressure systolic 100-120 mmHg, restore blood and fluid volume. Restore urine flow. Correction of homeostasis disorders. Symptomatic treatment is appropriate to the stage of the disease. Indications for extra-renal dialysis when necessary.

3.1 Conditions when appointing dialysis in acute renal failure Patients will be assigned early renal dialysis when there is 1 condition, mandatory renal dialysis is indicated when there are 2 conditions in the following conditions:
Does not meet In response to the therapeutic dose of Furosemide, urine output <200ml/day Blood urea >300 mmol/l Blood potassium > 6 mmol/l, cardiac arrhythmias, K+ rapidly increasing Volume burden, ALT increase, complications OAP Severe acidosis pH <7.2 Na+ blood > 160 mmol/l or <115 mEq/l 3.2 Methods of dialysis in acute renal failure Dialysis is a method of removing from the blood particles that are waste products in the blood. metabolism, endogenous and exogenous toxins, and water excretion to restore homeostasis. Common methods of dialysis are peritoneal dialysis and hemodialysis using an artificial kidney.
3.2.1 Acute peritoneal dialysis Peritoneal dialysis is a method of using the peritoneum as a filter, the abdominal cavity is the filtrate cavity and the blood cavity is the blood flowing in the blood vessels of the peritoneum. The exchange of substances between the blood and the peritoneal filtrate is carried out through the mechanism of private diffusion and osmosis. Peritoneal dialysis includes acute peritoneal dialysis and continuous peritoneal dialysis. In particular, acute peritoneal dialysis is indicated for acute renal failure and severe progression of chronic renal failure. Continuous peritoneal dialysis is indicated for patients with chronic renal failure with a glomerular filtration rate <15 ml/min.
Acute peritoneal dialysis is the technique of placing a temporary catheter through the abdominal wall into the peritoneal cavity, to the position close to the pocket with Douglas. Each time, 2 liters of filtrate are inserted into the peritoneal cavity, after 2 hours, the fluid is removed and 2 liters of new fluid are replaced. Do this continuously until the goals of lowering potassium, urea and serum creatinine are achieved, and kidney function is restored.
Acute peritoneal dialysis is often indicated for dialysis in acute renal failure when:
No artificial kidney Patient is contraindicated for hemodialysis due to severe cardiovascular disease, hemodynamic disorders, and coagulopathy. Using Heparin Peritoneal dialysis is contraindicated in the following cases:
Existing peritoneal infection. Peritoneal adhesions due to old incision or old trauma Peritoneal fibrosis, intra-abdominal tumors Having diaphragmatic hernia, abdominal wall or inguinal hernia Patient has severe chronic obstructive pulmonary disease (COPD) Patient is unable to comply with technical procedures

3.2.2 Artificial kidney Artificial kidney is a method of filtering blood by creating a circulation outside the body, the blood is led to a filter to filter excess water and waste products of metabolism, then blood is returned to the body. Thanks to the method of dialysis using an artificial kidney, the rate of patients dying from acute kidney failure from 70-80% previously decreased to about 10%.
Hemodialysis by hemodialysis is indicated in patients with acute renal failure, acute exacerbation of chronic kidney failure or in the treatment of some acute intoxication with barbiturates, heavy metals,...
Hemodialysis by hemodialysis is contraindicated Determined in the following cases:
Patients with severe cardiovascular diseases, when performing hemodialysis may have hemodynamic disturbances. The patient is in a state of shock and cardiovascular collapse. Patients with acute myocardial infarction, severe arrhythmia. Patients with coagulation disorders, should not use heparin Patients with end-stage cancer Patients without arteriovenous bridges Complications that can occur when dialysis with hemodialysis are: Hypotension pressure, nausea, vomiting, headache, chest pain, fever, chills, itching,... Uncommon but often serious complications include: osmotic imbalance syndrome, dialysis dementia syndrome , dialysis intolerance syndrome, cardiac tamponade syndrome due to effusion or pericardial effusion,...
Doctor Nguyen Hung graduated as a specialist in General Internal Medicine - University of Medicine and Pharmacy, Ho Chi Minh City ; Can speak English and French. With over 36 years of experience in the profession, of which 17 years is the Head of the Department of Endocrinology - Endocrinology, Da Nang Hospital, the doctor has experience in treating endocrine - diabetes and kidney diseases. Currently, he is an endocrinologist at the Department of Medical Examination & Internal Medicine at Vinmec Danang International General Hospital.