Management of End-Stage Renal Disease

Medication Management

Perform comprehensive medication reconciliation at each transition of care to prevent medication discrepancies, as recommended by the American Journal of Kidney Diseases 1
Avoid nephrotoxic agents such as NSAIDs, aminoglycosides, and radiocontrast agents to prevent further kidney damage, as recommended by the American Journal of Kidney Diseases 2
Consider using ACE inhibitors or ARBs with careful monitoring, as recommended by the European Renal Association 2, 3
Adjust or temporarily suspend antihypertensive medications before dialysis, and prefer short-acting agents that allow for rapid adjustments, as recommended by the American Journal of Kidney Diseases 4, 2

Patients with ESRD may have suboptimal antibody response to COVID-19 vaccination, and a COVID-19 booster vaccination should be considered 5

Measure residual kidney function every 4 months using 24-hour urine collection, as recommended by the National Kidney Foundation 2
For patients with residual kidney function (urine Kt/Vurea > 0.1/wk), measure total solute clearance within the first month and every 6 months thereafter, as recommended by the American Journal of Kidney Diseases 6
For patients without residual kidney function, maintain peritoneal Kt/Vurea at least 1.8/wk, as recommended by the American Journal of Kidney Diseases 6
Optimize ultrafiltration by avoiding excessive ultrafiltration rates (keeping below 6 ml/h per kg) to prevent hypotension, as recommended by the National Kidney Foundation 3

Use isotonic crystalloids (0.9% saline) to achieve a urine output of at least 200-300 mL/hour until CK levels begin to decrease again, as recommended by the American Journal of Kidney Diseases 7
Maintain a target urine output of 200-300 mL/hour to prevent further kidney damage 7
Monitor for signs of volume overload (pulmonary edema, peripheral edema) during aggressive fluid management 7
Implement sodium restriction (85-100 mmol/day) in patients with persistent hypertension, and consider liberalizing salt intake in patients with a tendency towards hypotension, as recommended by the American Journal of Kidney Diseases 2

Monitor BUN, creatinine, and electrolytes daily to closely monitor renal function 2
Monitor urine output and consider 24-hour urine collection every 3-4 months to assess residual kidney function, as recommended by the American Journal of Kidney Diseases 2, 6
Monitor blood pressure continuously during dialysis and establish individualized but strict blood pressure targets, as recommended by the American Journal of Kidney Diseases 6, 4
Monitor for symptoms of orthostatic hypotension and assess blood pressure patterns both during and between dialysis sessions, as recommended by the American College of Cardiology 2

Ensure adequate nutrition to support overall health and well-being, as suggested by the Academy of Nutrition and Dietetics 3
Educate patients on the importance of adhering to dietary restrictions and recognizing symptoms that require immediate medical attention, as recommended by the American Journal of Kidney Diseases 6

No specific guidelines available in the provided facts, but consider involving a multidisciplinary team to provide comprehensive care for patients with ESRD.