MEDizzy - A patient with acute kidney injury has been anuric for 12

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Nephrology and urology

A patient with acute kidney injury has been anuric for 12 hours despite fluid challenges. Potassium is 5.2 mmol/L, urea is very high and a pericardial rub is audible. The patient appears euvolaemic. A decision is made to commence haemodialysis due to concerns regarding uraemia and specifically uraemic pericarditis. What will the first dialysis session involve?

ExplanationThe first dialysis is designed to be a short, incomplete treatment due to the risks of dialysis disequilibrium syndrome if the uraemia is corrected too quickly. Therefore a short session is performed, using a small surface area dialyser with low blood and dialysate flows. Anticoagulation is generally not used for the first session, as a dialysis catheter will recently have been placed, and in this case also due to concerns regarding uraemic pericarditis, which may be haemorrhagic precipitating tamponade.