• Initiate RRT emergently when life-threatening changes in fluid, electrolyte, and acid-base balance exist
  • Consider the broader clinical context, the presence of conditions that can be modified with RRT, and trends of laboratory tests rather than single BUN and creatinine thresholds alone when making the decision to start RRT
  • Refer adults, children, and young people immediately for RRT if any of the following are not responding to medical management:
    • ↑ K+
    • Metabolic acidosis
    • Complications of uraemia (i.e., pericarditis, encephalopathy)
    • Fluid overload
    • Pulmonary oedema
  • Base the decision to start RRT on the condition of the adult, child, or young person as a whole and not on an isolated urea, creatinine, or potassium value.