Advanced CKD
Calculators: crcl
Dialysis indications = AEIOU: Acidosis · Electrolytes (refractory ↑K) · Ingestion/toxin · Overload (refractory) · Uremia (pericarditis, encephalopathy)
Chronic: EPO + iron (anemia); phosphate binders + vitamin D (bone); pre-dialysis CKD: SGLT2 inhibitor if eGFR ≥20 (with/without diabetes); finerenone for T2DM with albuminuria (KDIGO 2024)
Order set U&E, Ca, PO₄, PTH FBC, iron VBG Fluid/K⁺ assessment Criteria Admit Uraemic emergency or fluid/electrolyte crisis
ICU Pulmonary oedema, hyperkalaemia with ECG changes, pericarditis
Dialysis AEIOU
CRRT If used in ICU: regional citrate anticoagulation first-line; effluent dose 20–25 mL/kg/h
Discharge Dialysis access/schedule, electrolytes safe, euvolaemic
Key Fatigue alone is NOT a dialysis indication. Clinical detail — differentials, red flags, pitfalls, disposition Red flags Hyperkalaemia Pulmonary edema Uraemic pericarditis/encephalopathy Differentials Acute-on-chronic AKI Reversible contributors Common mistakes Missing AEIOU dialysis indication Nephrotoxic drug dosing Disposition & follow-up Dialysis access/plan; manage anaemia + bone disease.
Discharge package Medications Phosphate binders, active vitamin D, EPO/iron; renal drug dosing
Follow-up Dialysis unit; access care
Vaccination Hepatitis B, influenza, pneumococcal
Lifestyle Fluid/potassium/phosphate diet
Warning symptoms Missed dialysis symptoms, access problems, breathlessness
💊 Treatment detail — doses & preparation Erythropoietin (EPO) ESA
Dose 50–100 U/kg SC/IV 3×/wk (CKD anaemia, Hb 90–105 target)
Preparation Pre-filled syringes, refrigerate
Monitor BP, Hb 2–4 wkly, iron stores first; avoid Hb >115 (stroke risk)
Sevelamer phosphate binder
Dose 800–1600 mg TDS with meals
Preparation 800 mg tablets — swallow whole with food
Monitor Phosphate, GI upset; separates other drugs' absorption
Calcium carbonate phosphate binder/Ca²⁺
Dose 500 mg–1 g TDS with meals
Preparation 500 mg/1.25 g chewable tablets
Monitor Ca²⁺, phosphate; constipation
Cholecalciferol vitamin D
Dose Load 50,000 IU weekly ×6–8 wk (deficiency), then 800–1000 IU OD
Preparation Capsules/ampoules
Monitor Ca²⁺, 25-OH-D after loading
Dialysis planning definitive
Dose AV fistula creation 6–12 mo before anticipated start
Preparation Surgical mapping of veins
Monitor Fistula thrill/bruit checks
📖 KDIGO CKD Reviewed July 2026