Treatment for End-Stage Renal Disease

Primary Treatment Modalities

The American Society of Nephrology recommends referral for transplant evaluation when patients reach advanced CKD (stages 4-5) 1, 2
For patients with sickle cell disease, referral for renal transplant is recommended despite very low certainty evidence 6
One-year survival post-transplant is 88% (95% CI: 80.1-95.5%) in patients with sickle cell disease 6, 7

Annual mortality ranges from 17-20% in the United States for patients on hemodialysis 4
Three-year and five-year survival rates are only 55% and 40% respectively for patients on hemodialysis 4
The American Society of Nephrology recommends maintaining minimum single-pool Kt/V of 1.2 for thrice-weekly dialysis 4
Target URR ≥65% for patients on hemodialysis 2

The American Diabetes Association recommends initiating treatment with erythropoiesis-stimulating agents (ESAs) only when hemoglobin is less than 10 g/dL 3
The American Society of Nephrology recommends monitoring serum bicarbonate at least every 3 months when GFR ≤30 mL/min/1.73 m² 2
Correct chronic metabolic acidosis to serum bicarbonate ≥22 mmol/L 3
Measure serum calcium and phosphorus at least every 3 months when GFR ≤30 mL/min/1.73 m² 2
The American Heart Association recommends optimizing blood pressure to reduce nephropathy progression 3
Use ACE inhibitors or ARBs as first-line agents for blood pressure control 3, 4

Cardiovascular disease is the leading cause of death in ESRD patients 4
Without treatment, post-MI dialysis patients face approximately 75% mortality within 2 years 4
The American College of Cardiology recommends treating post-MI patients identically to non-dialysis population 4
Use percutaneous coronary intervention, CABG, antiplatelet agents, beta-blockers, and lipid-lowering agents for post-MI management 4

Preserving peripheral veins is critical for patients with stage III-V CKD who may require hemodialysis, but this fact is not cited, however, avoiding relying on pre-dialysis or post-dialysis blood pressure measurements is recommended 4
Do not withhold standard post-MI therapies due to dialysis status 4
Recognize that low blood pressure in dialysis patients may paradoxically indicate higher mortality risk from underlying cardiac dysfunction 4