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    End Stage Renal Disease (ESRD)

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    Assessment & Plan (long)

    # 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
    - potassium
    - pH

    Routine Management:
    - 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
    - HTN
    - 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)

    Educational

    Contrast Considerations:
    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.

    Contrast Nephropathy:
    High risk: diabetics, proteinuria, AKI, CKD4-5, heart / liver failure, dehydration.
    Pretreatement:
    - 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

    Organ systems
    • Renal/Electrolytes
    Medical field
    • Internal medicine
    Setting
    • Inpatient
    Author
    jason
    Page info

    Originally created: September 4, 2021 by jason

    [xyz-ips snippet="lastupdated"] [xyz-ips snippet="sectioneditor"] [post-views]

    Number of revisions: [xyz-ips snippet="numrevisions"]

    References
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