Meet the Expert 6

Timing of Dialysis

Session Overview

Deciding when to discontinue or resume dialysis is one of the most challenging aspects of managing patients recovering from acute-on-chronic kidney disease. Premature discontinuation may lead to recurrent complications, whereas unnecessary continuation may expose patients to hypotension, vascular access complications, and delayed kidney recovery.

This session will feature an elderly patient with advanced CKD and Child-Pugh B cirrhosis who developed MSSA bacteremia-associated acute-on-chronic kidney disease. The course was complicated by severe uremic bleeding from a duodenal Dieulafoy’s lesion, requiring endoscopic clipping and urgent hemodialysis. Dialysis was subsequently discontinued after stabilization and improvement in urine output. Although kidney function continued to improve, the patient later developed asymptomatic pulmonary congestion.

What Will Be Covered

• Practical criteria for liberation from kidney replacement therapy
• The roles of urine output, solute clearance, volume status, and metabolic stability
• Indications for resuming dialysis after initial discontinuation
• Balancing the risk of recurrent uremic bleeding against dialysis-related hemodynamic stress
• Assessment and management of congestion in patients with cirrhosis
• Use of diuretics after dialysis discontinuation
• Interpretation of asymptomatic pulmonary congestion
• Clinical usefulness and limitations of the Furosemide Stress Test
• Integrating clinical judgment with biomarkers and dynamic bedside assessment

What Participants Will Learn

Participants will learn how to determine whether kidney function is sufficient to support dialysis discontinuation and how to recognize when dialysis should be resumed. The session will also address how to manage persistent or recurrent congestion without relying solely on serum creatinine or urine output.

Target Audience

Nephrologists, intensivists, internists, hepatologists, fellows, residents, dialysis nurses, and other healthcare professionals involved in the management of acute-on-chronic kidney disease and kidney replacement therapy liberation.

停止透析與重新啟動的時機

課程簡介

對 acute-on-chronic kidney disease 病人而言，何時停止透析、何時需要重新啟動，是臨床上最困難的決策之一。過早停用可能造成尿毒症、體液過多或電解質異常再次惡化；但不必要地延長透析，也可能增加低血壓、血管通路併發症及腎功能恢復延遲的風險。

本場次將以一名合併 advanced CKD 與 Child-Pugh B 肝硬化的高齡病人為例。病人因 MSSA bacteremia 發生 acute-on-chronic kidney disease，後續出現嚴重尿毒性出血，並因十二指腸 Dieulafoy’s lesion 接受內視鏡止血及緊急 hemodialysis。病況穩定且尿量改善後停止透析，腎功能亦持續恢復，但後續影像顯示無症狀的肺部鬱血。

課程內容

• 停止 kidney replacement therapy 的實務判斷標準
• 尿量、溶質清除、體液狀態與代謝穩定度的評估
• 初次停止透析後，重新啟動治療的適應症
• 復發性尿毒性出血與透析相關血流動力學負荷之間的權衡
• 肝硬化病人的體液過多與肺部鬱血評估
• 停止透析後利尿劑的使用與調整
• 無症狀肺部鬱血的臨床判讀
• Furosemide Stress Test 的實際用途與限制
• 如何整合臨床判斷、biomarkers 與床邊動態評估

參與者將學到

參與者將學習如何判斷病人的腎功能是否足以停止透析，以及在停用後應追蹤哪些指標，才能及早辨識重新啟動透析的需要。

課程亦將探討如何處理持續或再次出現的體液過多，並避免僅依賴 serum creatinine 或尿量作為透析決策的單一依據。

適合對象

腎臟科、重症醫學科、一般內科及肝膽胃腸科醫師、研究醫師、住院醫師、透析護理師，以及參與 acute-on-chronic kidney disease 與透析停止評估的醫療專業人員。