1. Refractory Fluid Overload
2. Severe hyperkalemia (>6.5 mEq/L) or rapidly rising potassium levels
3. Signs of uremia including pericarditis, encephalopathy, or decline in mental status not explained by other abnormality/condition
4. Severe metabolic acidosis (pH<7.1)
5. Certain alcohol and drug intoxications

In patients with underlying chronic kidney disease (CKD), the likelihood of receiving dialysis increases in proportion to the decline in glomerular filtration rate (GFR) at baseline.


  1. Pannu N, Klarenbach S, Wiebe N, et al. Renal replacement therapy in patients with acute renal failure: a systematic review. JAMA 2008; 299:793.
  2. Gaudry S, Hajage D, Schortgen F, et al. Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit. N Engl J Med 2016; 375:122.

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