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When serious infection causes septic shock resulting plunge in blood pressure can cripple kidney function, necessitating immediate dialysis. Days after septic shock strikes, a significant number who are treated with antibiotics and fluids can recovery without dialysis.
A team of French researchers has found that withholding dialysis for 48 hours does not increase the risk of kidney failure death. Septic shock is a dangerous reaction to serious infections, such as pneumonia or peritonitis. It results in system-wide inflammation that causes blood pressure to plummet and major organs, such as the kidneys, to fail.
According to the study, the criteria used to diagnose acute kidney injury are not very accurate making it impossible to predict accurately those that need dialysis. Dialysis is invasive and there’s a risk of infection and bleeding. Researchers focused on nearly 500 adult patients admitted to a French intensive care unit during the early stages of septic shock. All had signs of kidney failure.
Half received dialysis within 12 hours of onset of kidney failure. Unless they got worse, the other half received dialysis only after 48 hours, if they needed it.Three months later, 58 percent of patients who had immediate dialysis had died, compared with 54 percent of those who delayed dialysis. What’s more, 29 percent of patients who waited recovered without dialysis.
In the absence of emergency criteria necessitating immediate dialysis, then clinicians can safely wait for 48 hours before starting renal replacement therapy, without incurring any extra risk for the patient, as long as they continue to monitor the patient closely for any signs of complication.
Dialysis is invasive and should only be used when necessary, running a patient’s blood through a machine to clear out toxins lowers blood pressure, and people with septic shock already have very low blood pressure.