Management of End-Stage Renal Disease

Vascular Access Management

Arteriovenous access is strongly preferred over central venous catheters for patients receiving hemodialysis, as it is associated with fewer infections and complications, according to the American Journal of Kidney Diseases guidelines 1
For patients who must use central venous catheters, "closed connector" devices should be used to reduce infection risk, as recommended by the American Journal of Kidney Diseases guidelines 1
Rope-ladder cannulation is preferred over buttonhole cannulation for patients with arteriovenous fistulas unless antimicrobial prophylaxis is used, as suggested by the American Journal of Kidney Diseases guidelines 1
If buttonhole cannulation is necessary, mupirocin antibacterial cream should be applied to reduce infection risk, according to the American Journal of Kidney Diseases guidelines 1

Dialysate calcium of 1.50 mmol/L or higher should be used to maintain neutral or positive calcium balance, as recommended by the American Journal of Kidney Diseases guidelines 1
For intensive hemodialysis patients with hypophosphatemia, consider phosphate dialysate additives, as suggested by the American Journal of Kidney Diseases guidelines 1

Consider increasing dialysate sodium concentration to 148 mEq/L to manage muscle cramps, as recommended by the Praxis Medical Insights guidelines, although a non-Praxis source is preferred, this fact is included due to lack of alternative sources 2
Reduce dialysate temperature from 37°C to 34-35°C to increase peripheral vasoconstriction and manage muscle cramps, as suggested by the Praxis Medical Insights guidelines, although a non-Praxis source is preferred, this fact is included due to lack of alternative sources 2
Consider medications like midodrine (5-10 mg orally before dialysis) for persistent muscle cramps, as recommended by the Praxis Medical Insights guidelines, although a non-Praxis source is preferred, this fact is included due to lack of alternative sources 2

Regularly reassess dry weight to prevent volume overload and intradialytic hypotension, as recommended by the Praxis Medical Insights guidelines, although a non-Praxis source is preferred, this fact is included due to lack of alternative sources 2
Educate patients on fluid restriction between sessions (interdialytic weight gain <4% of dry weight), as suggested by the Praxis Medical Insights guidelines, although a non-Praxis source is preferred, this fact is included due to lack of alternative sources 2
Consider sequential ultrafiltration for better hemodynamic stability, as recommended by the Praxis Medical Insights guidelines, although a non-Praxis source is preferred, this fact is included due to lack of alternative sources 2