From the Guidelines
Dialysis initiation should not be based solely on "CR greater than 3 or BUN greater than 100" as this is not a definitive indication for dialysis. The decision to initiate dialysis is complex and should be based on a composite assessment of a person’s symptoms, signs, quality of life, preferences, level of GFR, and laboratory abnormalities, as recommended by the KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease 1. Some key indications for dialysis include symptoms or signs attributable to kidney failure, such as neurological signs and symptoms attributable to uremia, pericarditis, anorexia, medically resistant acid-based or electrolyte abnormalities, intractable pruritus, serositis, and acid-base or electrolyte abnormalities, as outlined in the KDIGO guideline 1. Other important considerations for dialysis initiation include:
- Inability to control volume status or blood pressure
- Progressive deterioration in nutritional status refractory to dietary intervention
- Cognitive impairment
- Hyperkalemia, especially severe, with levels >6.5 mEq/L
- Severe metabolic acidosis It is essential to individualize the decision to start dialysis based on the patient's clinical status, rate of decline in kidney function, and presence of uremic complications rather than relying solely on specific laboratory thresholds, as emphasized by the KDIGO 2024 guideline 1.
From the Research
Indications for Dialysis
The following are indications for dialysis:
- Hyperkalemia: a condition where the serum potassium level is higher than normal, which can be life-threatening if left untreated 2, 3, 4
- Metabolic acidosis: a condition where the body's fluids become too acidic, which can occur in patients with chronic kidney disease 5, 6
- Elevated blood urea nitrogen (BUN) levels: a waste product that can build up in the blood when the kidneys are not functioning properly 5
Exceptions
There is no clear indication that a creatinine (CR) level greater than 3 is an absolute indication for dialysis, as the decision to initiate dialysis depends on various factors, including the patient's overall health, symptoms, and laboratory results 5. However, a BUN level greater than 100 can be an indication for dialysis, as it suggests a significant buildup of waste products in the blood.
Relevant Studies
Studies have shown that dialysis is an effective treatment for hyperkalemia, metabolic acidosis, and elevated BUN levels in patients with chronic kidney disease 2, 3, 5, 4, 6. However, the decision to initiate dialysis should be based on individual patient factors and shared decision-making between the patient and clinician 5.