When is dialysis indicated in the treatment of acute tubular necrosis (ATN)?

Updated: Mar 15, 2021
  • Author: Sangeeta Mutnuri, MBBS; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Indications for urgent dialysis in patients with ATN include the following:

  • Refractory fluid overload
  • Severe hyperkalemia
  • Signs of uremia (eg, pericarditis, encephalopathy, altered mental status)
  • Severe metabolic acidosis (pH <7.1)

In patients without one of those indications for dialysis, initiating renal replacement therapy (RRT) prophylactically offers no benefit over performing RRT as and when required. Several trials and a recent meta-analysis have shown no improvement in outcome with early versus late RRT for patients with AKI. [28]


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