Management of ESRD Patients

Dialysis Prescription and Modality

Conventional hemodialysis consists of 3 sessions per week, 3-5 hours per session, and remains the standard approach for ESRD patients, according to the American Journal of Kidney Diseases 1
Short daily hemodialysis, long hemodialysis, and long-frequent hemodialysis are alternative options for selected patients with preserved urine output and dietary discipline, as recommended by the American Journal of Kidney Diseases 1
Buttonhole cannulation techniques require specific antimicrobial prophylaxis considerations for intensive hemodialysis, as noted by the American Journal of Kidney Diseases 1

ESRD patients on maintenance hemodialysis require 1.2 g protein/kg body weight/day with at least 50% high biological value protein, and energy intake of 35 kcal/kg/day for patients <60 years or 30-35 kcal/kg/day for those ≥60 years, according to Praxis Medical Insights 2
Maintenance hemodialysis patients require 1.2 g protein/kg/day, ≥50% high biological value, as recommended by Praxis Medical Insights 2
Protein-energy malnutrition is common and associated with increased mortality, particularly when present at dialysis initiation, as noted by Praxis Medical Insights 2
Regular nutritional monitoring every 1-3 months is necessary, with more frequent monitoring if inadequate intake or malnutrition is present, according to Praxis Medical Insights 2
Education and dietary counseling are the first-line interventions for nutritional management, with creative menu planning considering patient preferences, as recommended by Praxis Medical Insights 2

Medication reconciliation must be performed at every care transition to prevent adverse drug events, as ESRD patients face altered pharmacokinetics requiring dose adjustments for most medications, according to the American Journal of Kidney Diseases 5
Medication reconciliation is the cornerstone of medication safety and must be prioritized at all care transitions, as noted by the American Journal of Kidney Diseases 5
ESRD patients are at heightened risk of adverse drug reactions due to polypharmacy, multiple comorbidities, and altered medication pharmacokinetics, according to the American Journal of Kidney Diseases 5
Acyclovir and gabapentin require significant dose reduction in dialysis patients to prevent toxicity, as recommended by the American Journal of Kidney Diseases 5
Oxycodone/acetaminophen requires careful dosing and monitoring, according to the American Journal of Kidney Diseases 5
Avoid phosphate-containing medications given ESRD status, as noted by Praxis Medical Insights 4
Avoid nephrotoxic contrast when possible, but do not withhold necessary CT angiography when diagnostic benefit outweighs risk in life-threatening presentations, according to Praxis Medical Insights 4

Monitor calcium balance considering dialysate calcium concentration, calcium-based phosphate binders, and ultrafiltration volumes, as recommended by the American Journal of Kidney Diseases 3
Increasing bone alkaline phosphatase and PTH suggest higher dialysate calcium may be required, according to the American Journal of Kidney Diseases 3
Bicarbonate supplementation should be adjusted when increasing dietary protein intake, as noted by Praxis Medical Insights 2
Malnutrition at dialysis initiation predicts future mortality risk, according to Praxis Medical Insights 2
Nutritional decline becomes particularly notable when GFR falls below 25 mL/min, as noted by Praxis Medical Insights 2
Regular assessment of serum albumin, transferrin, and anthropometric measurements is essential, according to Praxis Medical Insights 2