Research Information System
in: All Aspects of Hemodialysis, NOVA Publications , pp.63-86, 2025
Acute kidney injury (AKI) is a significant cause of morbidity and mortality, particularly in hospital settings. Despite advances in renal replacement therapy (RRT), the mortality rate for critically ill patients with AKI remains high. When indications arise, acute RRT is initiated for AKI patients. The available modalities for acute RRT include peritoneal dialysis, intermittent hemodialysis (HD), and continuous renal replacement therapy (CRRT). Studies have not conclusively shown superiority among these modalities in critically ill patients requiring acute dialysis. This paper reviews the prescription components of acute hemodialysis for AKI patients. The dialysis prescription consists of the choice of hemodialysis membrane, session duration, blood flow rate, dialysate composition, ultrafiltration rate, and anticoagulation. The selection of the dialyzer is crucial as synthetic membranes are commonly preferred due to their better biocompatibility and lower rates of infection-related complications. Additionally, dialysate composition is dynamically adjusted in acute hemodialysis to address rapid metabolic abnormalities, particularly acidosis and hyperkalemia. Key factors such as session duration and blood flow rate are tailored according to patientspecific conditions, including the severity of uremic symptoms and electrolyte imbalances. Acute HD sessions typically last 3.5 to 4 hours, with careful attention given to ultrafiltration targets and anticoagulation to prevent clotting in the dialysis circuit. This review underscores the importance of individualized dialysis prescriptions based on clinical parameters and highlights the role of careful monitoring and adjustment of hemodialysis settings to optimize patient outcomes in the management of AKI.