What are the classic indications for initiating dialysis in CKD?

• A. AEIOU: Acidosis, Electrolyte disturbances, Ingestions/toxins, Overload, Uremia
• B. Hypertension
• C. Infections
• D. Anemia

Answer: (D)

Dialysis is started when CKD patients develop life-threatening or hard-to-control complications, best remembered by the AEIOU indicators: Acidosis, Electrolyte disturbances, Ingestions/toxins, Overload, and Uremia. Persistent or refractory metabolic acidosis signals that the kidneys aren’t clearing acid effectively and that bicarbonate therapy isn’t enough. Dangerous electrolyte disturbances, especially high potassium, may require dialysis when medical measures fail to stabilize them. Ingestions or toxins that dialysis can effectively remove—certain drug overdoses or toxic substances—are another clear trigger. Volume overload causing pulmonary edema or heart failure despite maximal diuretic therapy indicates the need for dialysis. And overt uremic symptoms—encephalopathy, pericarditis, severe nausea/vomiting, or bleeding due to uremic platelet dysfunction—also prompt initiation.

Anemia, while common in CKD due to reduced erythropoietin production, is managed with anemia-directed therapies and is not itself an automatic reason to start dialysis.