Indications and Contraindications to Common Renal Replacement Therapies

Hemodialysis

Renal insufficiency or failure (acute or chronic) with any of the following that cannot otherwise be controlled:

• Fluid overload (including refractory heart failure)

• Hyperkalemia

• Hypercalcemia

• Metabolic acidosis

• Pericarditis

• Uremic symptoms

• GFR* < 10 mL/min/1.73 m² BSA (chronic kidney disease, no diabetes)

• GFR* < 15 mL/min/1.73 m² BSA (chronic kidney disease, diabetes)

• Some poisonings

Uncooperative or hemodynamically unstable patient

Peritoneal dialysis

Same indications as for hemodialysis (except for poisonings) in patients who

• Have inadequate vascular access

  or

• Prefer self-therapy

Absolute:

• Loss of peritoneal function

• Adhesions that limit dialysate flow

• Recent abdominal wounds

• Abdominal fistulas

• Abdominal wall defects that prevent effective dialysis or increase infection risk (eg, irreparable inguinal or diaphragmatic hernia, bladder extrophy)

• Patient’s condition not amenable to dialysis

Relative:

• Abdominal wall infection

• Frequent episodes of diverticulitis

• Inability to tolerate large volumes of peritoneal dialysate

• Inflammatory bowel disease

• Ischemic colitis

• Morbid obesity

• Peritoneal leaks

• Severe undernutrition

Hemoperfusion

Uncooperative or hemodynamically unstable patient