A 58-year-old man with diabetic CKD stage G5 (eGFR 9 mL/min) reports pleuritic chest pain. There is a pericardial friction rub, and echocardiography shows a small circumferential pericardial effusion. Potassium is 5.3 mEq/L, bicarbonate 17 mEq/L, and haemoglobin 9.0 g/dL. The finding that constitutes an urgent indication for initiating dialysis is:

• A Uraemic pericarditis ✓
• B Serum bicarbonate of 17 mEq/L
• C Potassium of 5.3 mEq/L
• D Haemoglobin of 9.0 g/dL

Explanation

Uraemic pericarditis is an absolute indication for emergency dialysis because untreated it may progress to haemorrhagic effusion and tamponade. Mild acidosis, potassium below 6 mEq/L, and moderate anaemia are managed medically with oral alkali, dietary counselling, and erythropoiesis-stimulating agents respectively. The classic emergency dialysis mnemonics group pericarditis with refractory hyperkalaemia, severe acidosis, fluid overload, and overt uraemic encephalopathy.

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

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Written and medically reviewed by the StethoPrep medical team.