Which of the following is an indication to start renal replacement therapy in AKI?

• A. Refractory hyperkalemia
• B. Volume overload that is manageable with diuretics
• C. Mild azotemia without symptoms
• D. Asymptomatic anemia

Answer: (A)

The key idea is recognizing urgent problems in AKI that dialysis can rapidly correct. Refractory hyperkalemia is the clearest reason to start renal replacement therapy because when potassium remains high despite initial medical treatments, there is a real and imminent risk of dangerous heart rhythms or arrest. Dialysis provides a fast and reliable way to lower serum potassium, correct acidosis, and remove toxins, which is why this scenario is the strongest indication among the options.

If the volume overload can be controlled with diuretics, dialysis isn’t immediately required; you’d pursue diuretic therapy and other measures first. Mild azotemia without symptoms doesn’t mandate dialysis because there are no harmful effects driving urgency. An asymptomatic anemia likewise isn’t an automatic reason for dialysis—anemia is managed with other therapies and transfusion decisions as appropriate, not by replacing kidney function.