Which of the following findings in a patient with advanced CKD constitutes an urgent indication for initiating dialysis?

• A Uraemic pericarditis with a friction rub ✓
• B Blood urea nitrogen of 95 mg/dL with mild anorexia
• C Serum creatinine of 9 mg/dL with eGFR of 6 mL/min and no symptoms
• D Serum bicarbonate of 19 mEq/L responding to oral sodium bicarbonate

Explanation

Absolute or urgent indications for dialysis are summarised by the mnemonic AEIOU: acidosis refractory to medical therapy, electrolyte abnormality (refractory hyperkalaemia), intoxication with dialysable poisons, overload refractory to diuretics, and uraemic complications such as encephalopathy or pericarditis. Uraemic pericarditis signals severe uraemia and risks progression to tamponade, so it mandates prompt dialysis. Asymptomatic patients with very low eGFR or high urea alone are managed with planned initiation rather than emergency dialysis.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.