Indications for Renal Replacement Therapy

Electrolyte Imbalances Unresponsive to Medical Management

Renal replacement therapy (RRT) is a life-saving intervention for patients with severe kidney dysfunction. Among the most critical indications for initiating RRT is the presence of electrolyte imbalances that fail to respond to conventional medical management.

Common Electrolyte Imbalances Necessitating RRT

• Hyperkalemia: Life-threatening potassium elevations (>6.5 mmol/L) despite medical interventions such as insulin, bicarbonate, and diuretics.
• Severe metabolic acidosis: Persistent acid-base disturbances with pH <7.1 that remain refractory to bicarbonate therapy.
• Hyperphosphatemia: Excessive phosphate levels contributing to cardiovascular complications and refractory to dietary and pharmacologic control.

Criteria for Initiating Renal Replacement Therapy

The following clinical parameters guide the decision to begin RRT:

• Ongoing electrolyte disturbances unresponsive to medical therapy
• Severe volume overload with pulmonary edema
• Uremic complications such as pericarditis or encephalopathy

Conclusion

Renal replacement therapy remains the cornerstone of management for life-threatening electrolyte disturbances when conventional medical approaches fail. Timely initiation improves survival and prevents severe systemic complications.