Timing of Dialysis

This session will focus on the timing of dialysis discontinuation and resumption in patients recovering from acute-on-chronic kidney disease.

The case involves an elderly patient with advanced CKD and Child-Pugh B cirrhosis who developed MSSA bacteremia-associated acute-on-chronic kidney disease, complicated by severe uremic bleeding from a duodenal Dieulafoy’s lesion requiring endoscopic clipping and urgent hemodialysis. After stabilization, urine output improved and dialysis was discontinued; however, despite subsequent improvement in renal function, the patient developed asymptomatic lung congestion.

The discussion will address practical criteria for RRT liberation, triggers for resuming dialysis, the balance between recurrent uremic bleeding and unnecessary hemodynamic stress, management of congestion in cirrhotic patients off dialysis, and the real-world usefulness and limitations of tools such as the Furosemide Stress Test.