Management of End-Stage Renal Disease (ESRD) with Anuria

Renal Replacement Therapy Options

For patients receiving hemodialysis, arteriovenous access (AVF or AVG) is recommended over tunneled central venous catheters (CVC) 1
For patients using CVC for hemodialysis access, "closed connector" devices are suggested to reduce infection risk 2
For patients using buttonhole cannulation technique with AVF, mupirocin antibacterial cream is recommended to reduce infection risk 2

Intensive hemodialysis regimens (more frequent and/or longer sessions) may improve quality of life, blood pressure control, and reduce left ventricular hypertrophy 3
For patients on intensive hemodialysis, a dialysate calcium of 1.50 mmol/L or higher is recommended to maintain neutral or positive calcium balance 2
If hypophosphatemia develops during intensive hemodialysis, phosphate dialysate additives should be considered after stopping phosphate binders and liberalizing diet 2

Insulin (0.1 units/kg) plus glucose (25% dextrose 2 mL/kg) is recommended for acute management of hyperkalemia 4
Calcium carbonate (100-200 mg/kg/dose) and sodium bicarbonate are recommended for myocardial membrane stabilization in hyperkalemia management 4
ECG monitoring is essential during hyperkalemia management 4

Persistent hyperkalemia unresponsive to medical therapy is an indication for urgent dialysis 4
Severe metabolic acidosis is an indication for urgent dialysis 4
Volume overload unresponsive to diuretic therapy (in patients with residual function) is an indication for urgent dialysis 4
Overt uremic symptoms including pericarditis and severe encephalopathy are indications for urgent dialysis 4
Severe progressive hyperphosphatemia (>6 mg/dL) or symptomatic hypocalcemia are indications for urgent dialysis 4

ACE inhibitors or angiotensin receptor blockers are preferred for hypertensive patients with proteinuria 5
Calcium channel blockers should be avoided in patients receiving protease inhibitors due to potential interactions 5

Frequent dialysis sessions may be required to adequately control uremic symptoms and fluid status 4