# End Stage Renal Disease (ESRD)
Hemodialysis vs. Peritoneal dialysis, Treatment location and schedule, Date of last dialysis: ***
Access HD: (fistula, graft, catheter) or ...PD: catheter
fistula - native vein or artery
graft - artificial conduit connecting native vein and artery
catheter - temporary (vascath) or tunneled/permanent (permacath)
- consult IR if weak thrill or pulsatility (stenosis)
- patient making urine?
- assess volume status, oxygen, BP
- No BP or labs in access arm (No PICC or IVs or subclavian lines in the nondominant arm of CKD 4-5 pt's)
- renal diet (low K and phos)
- dose meds appropriately
- No maintenance IVF
-be very cautious repleting electrolytes
- goal Hb 9.5-11, check iron stores, consider ESA as out pt
- Bone mineral disease (phos binder with meals, hold if NPO. calcium binders (Ca carbonate vs sevelamer or lanthanum)
if pt still makes urine avoid iodinated contrast. If used, maintain dialysis schedule.
Avoid gadolinium if GFR＜30 (risk of nephrogenic systemic fibrosis), if needed in life-threatening situtaion, dialyze immediately after GAD.
High risk: diabetics, proteinuria, AKI, CKD4-5, heart / liver failure, dehydration.
- hold diuretics,
- hold RAAS inhibitor if new med (ok if chronic med and renal fxn at baseline)
- hydrate, NS or NaB (sodium bicarb 150mEq in 1L). infuse 3cc/kg for 1 hour prior to contrast, 1cc/kg for 6 hours after contrast
- consider Mucomyst 1300mg bid, two doses before and after contrast
- supportive care and avoidance of additional injury if contrast injury manifests 12-48 hrs after administration of contrast