Support of renal function

In healthy individuals, the kidney serves the dual function of eliminating waste products and controlling fluid balance. Critically ill patients frequently sustain a loss of one or both of these renal functions and require support with dialysis. Dialysis the rapy is initiated whenthe level of waste products in the blood is toxic, or when fluid balance cannot be maintained with the aggressive use of diuretics. The major indications for emergency dialysis includefluid overload that compromises oxygenation, hyperkalemia that cannot be managed withion-exchange resins or diuretics, uncontrollable bleeding not attributable to a cause other than uremia, or anuria. Additional indications are summarized in Chapter 34.