Critically ill patients in the intensive care unit (ICU) are at high risk of sudden kidney problems, known as acute kidney injury (AKI). Critical care nephrology focuses on recognising and managing these problems early, working closely with the ICU team. Dr. Satarupa Deb, Consultant Nephrologist at Bombay Hospital, South Mumbai, provides kidney care for seriously ill patients, including decisions about dialysis in the ICU.
What Is Acute Kidney Injury?
Acute kidney injury is a sudden decline in kidney function, over hours to days. It is usually identified by a rise in serum creatinine or a fall in urine output. In the ICU, AKI is common and may occur alongside other serious illnesses.
Common causes include severe infection (sepsis), low blood pressure or dehydration, major surgery, heart failure, certain medicines or contrast dyes, and conditions seen frequently in India such as leptospirosis, malaria, dengue and snakebite. Often, more than one factor contributes.
How AKI Is Managed in the ICU
Management focuses on treating the underlying cause and supporting the kidneys while they recover.
- Careful fluid management to maintain adequate blood pressure without causing fluid overload
- Treating infection and other underlying conditions promptly
- Reviewing and adjusting medicines, avoiding those that may harm the kidneys
- Close monitoring of urine output, creatinine, potassium and acid-base balance
- Adjusting drug doses to match kidney function
- Starting kidney replacement therapy (dialysis) when needed
When Is Dialysis Needed in the ICU?
Not every patient with AKI needs dialysis. The decision is individualised and is based on the overall clinical picture rather than a single blood value. Dialysis may be considered for dangerously high potassium, severe acid build-up, fluid overload affecting breathing, complications of very high urea, or certain poisonings.
CRRT, SLED and Intermittent Hemodialysis
Several forms of dialysis may be used in the ICU, and the choice depends on the patient's blood pressure stability, fluid status and available resources.
- Continuous Renal Replacement Therapy (CRRT): runs slowly and continuously over 24 hours, allowing gentle removal of fluid and waste. It may be preferred for patients with unstable blood pressure or significant brain swelling.
- Sustained Low-Efficiency Dialysis (SLED): a hybrid approach run over a longer period than standard dialysis, often 6 to 12 hours, offering gentler fluid removal while using standard dialysis equipment.
- Intermittent Hemodialysis (IHD): standard sessions of a few hours, suitable for patients whose blood pressure is stable.
Recovery and Follow-Up After AKI
Many patients recover kidney function after AKI, either fully or partially, and are able to stop dialysis. However, an episode of AKI may increase the long-term risk of chronic kidney disease. Follow-up with a nephrologist after discharge is therefore advisable to check kidney function, review medicines and blood pressure, and plan ongoing care.
Dr. Satarupa Deb (MD Medicine, DM Nephrology, KEM Hospital, Mumbai) has treated more than 1000 patients across government and private hospitals over the last decade, and supports families with clear communication during a stressful time.
Frequently Asked Questions
Will my family member need dialysis permanently after AKI?
Not necessarily. Many patients recover enough kidney function to stop dialysis. Recovery depends on the cause, the severity of illness and prior kidney health. Regular monitoring helps assess progress.
What is the difference between CRRT and regular dialysis?
CRRT works slowly and continuously throughout the day, which is gentler on blood pressure. Regular hemodialysis is faster and done in sessions of a few hours. The ICU and nephrology teams choose the method based on the patient's condition.
Can AKI be prevented in hospital?
Not always, but the risk may be reduced by maintaining adequate hydration and blood pressure, avoiding kidney-harming medicines where possible, adjusting doses and monitoring kidney function in high-risk patients.
Do I need follow-up after leaving hospital?
Yes. Even if kidney function returns to normal, a follow-up check with a nephrologist, usually within a few months, is recommended to look for lasting kidney damage.
Consult Dr. Satarupa Deb
For a nephrology opinion on acute kidney injury or follow-up after an ICU stay, book a consultation with Dr. Satarupa Deb at Bombay Hospital, Marine Lines, South Mumbai. Call +91 9326786023 or +91 9833990040.
This page is for general information only and is not a substitute for a medical consultation. Please consult a qualified doctor for diagnosis and treatment.