Показання та протипоказання до загальної замісної ниркової терапії

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

Poisoning or toxicity (eg, due to barbiturates, many antidepressants, ethchlorvynol, meprobamate, paraquat, glutethimide, metals such as lithium and barium, or toxic doses of aminoglycosides or cardiovascular medications)

Uncooperative or hemodynamically unstable patient