Management of CKD with Uremic Neuropathy, Hyperkalemia, and Anemia

Primary Indication: Uremic Neuropathy

The American Society of Nephrology recommends initiating dialysis immediately in patients with uremic neuropathy, as it is a sign of advanced uremic toxicity that will not respond to conservative measures alone, with a glomerular filtration rate below 12 ml/min 1, 2

The European Society of Cardiology defines hyperkalemia as K+ >5.0 mEq/L, with 5.3 falling in the mild-to-moderate range, and recommends initiating renal replacement therapy for persistent hyperkalemia in the setting of uremic symptoms 1, 3, 4

The European Renal Association recommends initiating hemodialysis rather than continuous renal replacement therapy (CRRT) unless the patient develops hemodynamic instability, as intermittent hemodialysis provides rapid clearance of uremic toxins and potassium 1, 2
The American Society of Nephrology suggests that CRRT should be reserved for hemodynamically unstable patients or those with cerebral edema 2
The European Renal Association recommends frequent (daily) dialysis sessions may be needed initially given the continuous release of metabolites 1