Renal Replacement Therapy – Considerations

Indications for Renal Replacement Therapy (notes from TrueLearn)

-broad term : hemodialysis, peritoneal dialysis, hemofiltration, renal transplant
-CRRT is over 24hrs, best for HD unstable patients

Chronic Renal Failure indications
-fluid overload
-uremic symptoms
-GFR criteria

Indications in ICU patient
-pulmonary edema unresponsive to diuretics
-uncompensated metabolic acidosis (ph35, creatinine >400, hyperkalemia >6.5

Succ will raise K same as normal patient
watch fluid status and hemodynamics
avoid nephrotoxic agents (some a/b, nsaids)


Renal Tubular Acidosis


The table below provides a useful summary of some of the key points in differentiating the types of renal tubular acidosis.

Comparison of Major Types of RTA


 Type 1

 Type 2

 Type 4

Hyperchloraemic acidosis




Minimum Urine pH


 <5.5 (but usually >5.5 before the acidosis becomes established)


Plasma potassium 




Renal stones





Reduced H+excretion in distal tubule

Impaired HCO3reabsorption in proximal tubule

Impaired cation exchange in distal tubule