Q; All of the following are indications of starting hemodialysis (HD) in patients with Chronic Kidney Disease: (CKD) :

A) Pericarditis 
B) Pleuritis
C) Wrist or foot drop
D) Seizures
E) All of the above


Answer: E

Fluid overload, acidosis, hyperkalemia and other electrolyte disturbances are well known indications of emergent HD. But some of the manifestations of CKD and/or uremia are under-appreciated where relatively urgent intervention is needed like pericarditis or pleuritis, encephalopathy manifesting as confusion, asterixis, myoclonus, wrist or foot drop, or, even seizures. Also uncontrolled uremic bleeding diathesis may require HD sooner than later.


Reference: 

 Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis 2006; 48 Suppl 1:S2.