Hemodialysis or hemofiltration is initiated when Severe electrolyte abnormalities cannot otherwise be controlled (eg, potassium > 6 mmol / L) Pulmonary edema persists despite drug treatment Metabolic acidosis is unresponsive to treatment Uremic symptoms occur (eg, vomiting thought to be due to uremia, asterixis, encephalopathy, pericarditis, seizures) Blood urea nitrogen (BUN) and creatinine levels are probably not the best guides for initiating dialysis in acute kidney injury (AKI).