Acute kidney injury is a critical medical condition that can necessitate hemodialysis, a life-saving intervention. This article explores the causes, symptoms, and treatment options for AKI, focusing on the role of hemodialysis in managing this serious renal complication.
Introduction:
Acute kidney injury (AKI) is a heterogeneous syndrome defined by rapid (hours to days) decline in the glomerular filtration[1] rate (GFR), resulting in the retention of metabolic waste[2] products, including urea and creatinine, and dysregulation of fluid, electrolyte, and acid-base homeostasis[3]. Although often considered a discrete syndrome, AKI represents a broad constellation of pathophysiologic processes of varied severity and cause. These include decreases in the GFR[4] as the result of hemodynamic perturbations that disrupt normal renal perfusion[5] without causing parenchymal injury, partial or complete obstruction to urinary flow, and a range of processes with characteristic patterns of glomerular, interstitial, tubular, or vascular parenchymal injury. AKI occurs in a heterogeneous patient population-genetics, age, kidney functional status, accompanying comorbidities and the cause is often multifactorial.
Recent research suggests enhanced survival rates among hospitalized patients with AKI needing dialysis, with a potential 30% needing continued hemodialysis after leaving the hospital. Nevertheless, outcomes for many of these patients still show limited improvement. Those requiring dialysis for AKI tend to be older, suffer from more acute illnesses, and have a higher occurrence of chronic conditions linked to hospital stays. The patients recovered from AKI are at increased risk of long term adverse events including mortality, chronic kidney disease, End stage renal failure, cardiovascular events and reduced quality of life. The overall data available from India regarding AKI requiring dialysis are very less.
Indication for Dialysis in AKI:
- Volume overload refractory to diuretics
- Severe Hyperkalemia and Severe metabolic acidosis despite medical management
- Signs of uremia such as seizures, pericarditis
- Anuria for more than 24 hours.
Clinical manifestations:
Individuals experiencing AKI do not exhibit distinct clinical symptoms exclusive to the illness. Instead, they may display signs of the primary condition, such as heart failure, sepsis, systemic vasculitis, or thrombotic microangiopathy. AKI typically progresses through four stages: initiation, oligo-anuria, polyuria, and restitution. During stage 2 (oligo-anuria), indications of renal dysfunction become noticeable in this evolving process.
Initiation of Dialysis:
Early initiation of Renal replacement therapy (RRT) may produce benefits by avoiding hypervolemia, eliminating toxins, establishing acid-base homeostasis
However, early initiation of RRT may unnecessarily expose some patients to potential harm because some patients will spontaneously recover renal function.
Hence it should be decided by the nephrologists by assessing the risk benefit ratio on clinical background.
Challenges and Considerations:
While hemodialysis is effective, it presents challenges such as vascular access issues, the risk of infection, and the need for consistent medical supervision. Balancing the benefits and potential complications is crucial in the overall management of AKI.
Preventive Measures:
Preventing AKI involves addressing underlying risk factors, staying hydrated, and monitoring medications closely. Early intervention and regular medical check-ups play a key role in reducing the likelihood of developing severe kidney injury.
Dr. Vishnu Shankar
Dr. R. Balasubramaniyam