When are dialysis indications present? List at least four.

• A. Refractory hyperkalemia; refractory metabolic acidosis; fluid overload not responsive to diuretics; uremic symptoms (encephalopathy, pericarditis); eGFR <15
• B. Mild edema and well-controlled blood pressure
• C. Only elevated creatinine with no symptoms
• D. CKD stage 3 with preserved renal function

Answer: (A)

Dialysis is considered when the kidneys can no longer maintain the body's waste removal, acid-base balance, electrolyte levels, and fluid status. The strongest indications are when there are clear symptoms or life-threatening complications from kidney failure.

Uremic symptoms such as encephalopathy or pericarditis indicate toxins are building up and dialysis is needed to prevent harm. Refractory hyperkalemia means potassium levels remain dangerously high despite treatment, risking arrhythmias. Refractory metabolic acidosis shows the body cannot correct acid buildup with medical therapy alone. Fluid overload that does not respond to diuretics—leading to problems like pulmonary edema or severe hypertension—requires dialysis to remove excess fluid. A very low GFR, such as an eGFR below 15 mL/min/1.73 m2, signals advanced kidney failure and, when accompanied by symptoms or complications, often necessitates dialysis.

Milder scenarios don’t require dialysis: mild edema with well-controlled blood pressure can usually be managed with diuretics and other therapies; an isolated rise in creatinine without symptoms isn’t enough to start dialysis; CKD stage 3 with preserved renal function indicates only moderate impairment, not the need for dialysis.