Expansion
Accumulated toxins affect nearly every system once GFR falls very low
Expansion
- Neurological: encephalopathy, asterixis, seizures, peripheral neuropathy, restless legs
- Cardiovascular: pericarditis, accelerated atherosclerosis, hypertension, fluid overload and pulmonary oedema
- Haematological: anaemia from erythropoietin deficiency, and platelet dysfunction causing a bleeding tendency despite a normal platelet count
- Gastrointestinal: nausea, vomiting, anorexia, metallic taste, gastritis
- Metabolic: metabolic acidosis, hyperkalaemia, hyperphosphataemia, hypocalcaemia
- Bone: renal osteodystrophy from secondary hyperparathyroidism
- Skin: pruritus, sallow pigmentation, uraemic frost
- Endocrine: insulin resistance, reduced insulin clearance, infertility
The mnemonic AEIOU summarises urgent dialysis indications: severe Acidosis, Electrolyte disturbance (refractory hyperkalaemia), Intoxication with a dialysable poison, Overload refractory to diuretics, and Uraemic complications such as pericarditis or encephalopathy.
The bleeding tendency is worth noting particularly, since it affects procedural planning and is improved by desmopressin.