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AKI Renal Replacement Therapy Indications — FRCA Final MCQ

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ModerateIntensive Care MedicineAKI Renal Replacement Therapy IndicationsFRCA Final

A 72-year-old woman in the ICU has KDIGO stage 3 acute kidney injury. Despite appropriate medical management, hyperkalaemia, metabolic acidosis and clinically significant fluid overload persist. According to NICE NG148, which finding constitutes an indication for immediate referral for renal replacement therapy?

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Reveal the answer and explanation

Correct answer: D — Hyperkalaemia, metabolic acidosis or fluid overload not responding to medical management

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

C is correct. NICE recommends immediate specialist discussion and referral for renal replacement therapy when hyperkalaemia, metabolic acidosis, uraemic complications, fluid overload or pulmonary oedema is not responding to medical management. This patient has several such indications. NICE does not prescribe a single creatinine, urea or potassium threshold at which renal replacement therapy must begin; the decision is based on the patient's overall clinical condition. Therefore, an isolated creatinine above 300 micromol/L is insufficient. Stage 1 AKI with no complications and ICU admission alone are not indications. Option D does not meet the adult KDIGO oliguria criterion for diagnosing AKI and, even if sustained oliguria were present, urine output alone would not automatically mandate renal replacement therapy.

Reference: NICE. Acute kidney injury: prevention, detection and management (NG148), recommendations 1.5.6–1.5.11. Published 2019; updated 2024. https://www.nice.org.uk/guidance/ng148/chapter/Recommendations