Materiały źródłowe

• #1 End-Stage Renal Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499861/

  More than 500,000 people in the United States live with end-stage renal disease (ESRD). […] This activity explains when this condition should be considered in the differential diagnosis and how to evaluate this condition properly. Furthermore, it highlights the interprofessional team’s role in caring for patients with this condition. […] Summarize the treatment options for end-stage renal disease. […] Treatment of end-stage renal disease involves correcting parameters at the level of the patient’s presentation. Interventions aimed at slowing the rate of kidney disease should be initiated and can include: […] For uremic manifestations, long-term renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplantation) is needed. […] Early patient education should be initiated regarding natural disease progression, different modalities for dialysis, and renal transplantation.

• #2 End-Stage Renal Disease: Medical Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/34783494/

  End-stage renal disease (ESRD) is diagnosed when kidney function is no longer adequate for long-term survival without kidney transplantation or dialysis. […] Kidney transplantation typically yields the best patient outcomes, although most patients are treated with dialysis. […] A palliative approach to ESRD is a reasonable alternative to dialysis, particularly for individuals with limited life expectancy, with severe comorbid conditions, or who wish to avoid medical interventions. […] Controlling blood pressure in patients receiving dialysis improves mortality. […] Insulin is the preferred treatment for patients with ESRD and diabetes mellitus requiring medication. […] Clinicians must be aware of the many medical complications associated with ESRD.

• #3 End-Stage Renal Disease: Causes, Symptoms, and Treatment

  https://www.verywellhealth.com/end-stage-renal-disease-5216609

  End-stage renal disease (ESRD) is also known as kidney failure. It is often caused by chronic kidney disease (CKD) and is stage 5 or the final stage of CKD, which is when the kidneys stop functioning. ESRD is when 85% to 90% of kidney function is gone. […] There is no cure for ESRD, but people can live long lives with treatment and management. The main treatments for ESRD include: dialysis, kidney transplant, and medical management. […] Dialysis helps the body excrete waste and extra fluids in the blood. While it can help with what the kidneys usually do, it cannot do everything, so some medical and health problems from kidney failure may remain. […] A kidney transplant gives you a healthy kidney by implanting it via surgery. The kidney comes from either a live donor or a dead donor, and the new kidney can do everything a healthy kidney can do.

• #4 End-stage renal disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/end-stage-renal-disease/diagnosis-treatment/drc-20354538

  End-stage renal disease treatments include: […] A kidney transplant is often the treatment of choice for end-stage renal disease, compared with a lifetime on dialysis. […] After a successful kidney transplant, your new kidney filters your blood, and you no longer need dialysis. […] Dialysis does some of the work of your kidneys when your kidneys can’t do it themselves. […] Dialysis options include peritoneal dialysis and hemodialysis. […] If you choose not to have a kidney transplant or dialysis, you can choose palliative or supportive care to help you manage your symptoms and feel better. […] Without either dialysis or a transplant, kidney failure progresses, eventually leading to death.

• #5 Kidney Failure: Stages, ESRD, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17689-kidney-failure

  Kidney failure can worsen to the most severe stage, end-stage kidney disease (ESKD) which is deadly without treatment. If you have end-stage kidney disease, you may survive a few days or weeks without treatment. With the proper treatment, you can have a good quality of life while you manage kidney failure. […] If you’re in end-stage kidney failure, you need treatment to keep you alive. There are two main treatments for kidney failure: dialysis and a kidney transplant. […] Dialysis helps your body filter blood. You can think of it as giving your kidneys some relief, so they don’t have to work as hard to do their job. There are two types of dialysis: Hemodialysis and Peritoneal dialysis. […] A surgeon places a healthy kidney in your body during a kidney transplant to take over for your damaged kidney. The healthy kidney (donor organ) may come from a deceased donor or a living donor. […] With proper treatment, you can continue to live a happy, fulfilling life. But, you can expect to need treatment for the rest of your life. Remember, you can’t reverse kidney disease or kidney failure, you can only slow its progression.

• #6 Chronic kidney disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/diagnosis-treatment/drc-20354527

  Dialysis artificially removes waste products and extra fluid from your blood when your kidneys can no longer do this. In hemodialysis, a machine filters waste and excess fluids from your blood. […] A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors. […] After a transplant, you’ll need to take medications for the rest of your life to keep your body from rejecting the new organ. You don’t need to be on dialysis to have a kidney transplant. […] For some who choose not to have dialysis or a kidney transplant, a third option is to treat your kidney failure with conservative measures. Conservative measures likely will include symptom management, advance care planning and care to keep you comfortable (palliative care).

• #7 Kidney failure (ESRD) – Symptoms, stages, & treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/kidney-failure

  Kidney failure means your kidneys are no longer able to work well enough to keep you alive. With kidney failure, 85-90% of your kidney function is gone. People with kidney failure will need dialysis or a kidney transplant to survive. […] There is no cure for kidney failure, but with treatment it is possible to live a longer and productive life. […] Dialysis and kidney transplant are the two treatments for people with kidney failure. Dialysis treatments or a transplanted kidney will take over some of the work from your damaged kidneys and remove wastes and extra fluid from your body. This will make many of your symptoms better. You also have the option to choose not to pursue either option, also known as conservative management. […] Dialysis: There are two types of dialysis- hemodialysis and peritoneal dialysis. Both remove waste products and extra fluid from your blood. Hemodialysis uses an artificial kidney machine, while peritoneal dialysis uses the lining in the belly. Hemodialysis treatments can be done at your home or in a clinic. Peritoneal dialysis is usually done at your home.

• #8 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  End-stage renal disease (ESRD) is diagnosed when kidney function is no longer adequate for long-term survival without kidney transplantation or dialysis. […] Kidney transplantation typically yields the best patient outcomes, although most patients are treated with dialysis. […] A palliative approach to ESRD is a reasonable alternative to dialysis, particularly for individuals with limited life expectancy, with severe comorbid conditions, or who wish to avoid medical interventions. […] Insulin is the preferred treatment for patients with ESRD and diabetes mellitus requiring medication. […] Most patients elect to receive dialysis to treat their ESRD, and these patients tend to live longer than those choosing conservative management. […] Patients with ESRD can elect a palliative approach to managing their disease that does not involve dialysis. This approach emphasizes quality of life over the prolongation of life.

• #9 End-stage renal disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/end-stage-renal-disease/diagnosis-treatment/drc-20354538

  End-stage renal disease treatments include: […] A kidney transplant is often the treatment of choice for end-stage renal disease, compared with a lifetime on dialysis. […] After a successful kidney transplant, your new kidney filters your blood, and you no longer need dialysis. […] Dialysis does some of the work of your kidneys when your kidneys can’t do it themselves. […] Dialysis options include peritoneal dialysis and hemodialysis. […] If you choose not to have a kidney transplant or dialysis, you can choose palliative or supportive care to help you manage your symptoms and feel better. […] Without either dialysis or a transplant, kidney failure progresses, eventually leading to death.

• #10 Kidney failure (ESRD) – Symptoms, stages, & treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/kidney-failure

  Kidney failure means your kidneys are no longer able to work well enough to keep you alive. With kidney failure, 85-90% of your kidney function is gone. People with kidney failure will need dialysis or a kidney transplant to survive. […] There is no cure for kidney failure, but with treatment it is possible to live a longer and productive life. […] Dialysis and kidney transplant are the two treatments for people with kidney failure. Dialysis treatments or a transplanted kidney will take over some of the work from your damaged kidneys and remove wastes and extra fluid from your body. This will make many of your symptoms better. You also have the option to choose not to pursue either option, also known as conservative management. […] Dialysis: There are two types of dialysis- hemodialysis and peritoneal dialysis. Both remove waste products and extra fluid from your blood. Hemodialysis uses an artificial kidney machine, while peritoneal dialysis uses the lining in the belly. Hemodialysis treatments can be done at your home or in a clinic. Peritoneal dialysis is usually done at your home.

• #11 Chronic kidney disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/diagnosis-treatment/drc-20354527

  Dialysis artificially removes waste products and extra fluid from your blood when your kidneys can no longer do this. In hemodialysis, a machine filters waste and excess fluids from your blood. […] A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors. […] After a transplant, you’ll need to take medications for the rest of your life to keep your body from rejecting the new organ. You don’t need to be on dialysis to have a kidney transplant. […] For some who choose not to have dialysis or a kidney transplant, a third option is to treat your kidney failure with conservative measures. Conservative measures likely will include symptom management, advance care planning and care to keep you comfortable (palliative care).

• #12 Consumer Guide: Finding and Choosing an End Stage Renal Disease Treatment Facility | Wisconsin Department of Health Services

  https://www.dhs.wisconsin.gov/guide/esrd.htm

  End stage renal disease is also called end stage kidney disease. It’s a type of permanent kidney failure that requires regular treatment for the kidneys. Dialysis treatment is often provided two to three times per week for people with end stage renal disease. Dialysis gets rid of waste from the blood that the kidneys can’t remove. […] End Stage Renal Disease – Learn more about how end stage renal disease treatment facilities are regulated in Wisconsin.

• #13 Kidney failure (ESRD) – Symptoms, stages, & treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/kidney-failure

  Kidney failure means your kidneys are no longer able to work well enough to keep you alive. With kidney failure, 85-90% of your kidney function is gone. People with kidney failure will need dialysis or a kidney transplant to survive. […] There is no cure for kidney failure, but with treatment it is possible to live a longer and productive life. […] Dialysis and kidney transplant are the two treatments for people with kidney failure. Dialysis treatments or a transplanted kidney will take over some of the work from your damaged kidneys and remove wastes and extra fluid from your body. This will make many of your symptoms better. You also have the option to choose not to pursue either option, also known as conservative management. […] Dialysis: There are two types of dialysis- hemodialysis and peritoneal dialysis. Both remove waste products and extra fluid from your blood. Hemodialysis uses an artificial kidney machine, while peritoneal dialysis uses the lining in the belly. Hemodialysis treatments can be done at your home or in a clinic. Peritoneal dialysis is usually done at your home.

• #14 End-Stage Renal Disease | Nutrition Guide for Clinicians

  https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342059/all/End_Stage_Renal_Disease

  Hemodialysis typically involves the surgical creation of an arteriovenous fistula (a connection between an artery and vein), usually in the forearm. […] Peritoneal dialysis involves inserting the dialysate into the patients abdomen and allowing dialysis to occur continuously or intermittently without requiring the patient to travel regularly to a dialysis center. […] Both methods have advantages and disadvantages, and outcomes are similar. […] Elderly patients with ESRD, often with other comorbidities, may fare better with conservative management compared with initiation of dialysis. Median life expectancy in these patients can range from 6-23 months in the absence of renal replacement therapy.

• #15 End-Stage Renal Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21081

  Hyperphosphatemia is treated with phosphate binders (calcium acetate, sevelamer carbonate, or lanthanum carbonate) and dietary phosphate restriction. […] Lifestyle modification and dietary restrictions are routinely recommended. For example, adhering to a low salt diet (less than 2 g/day), a renal diet (avoiding foods that are high in phosphorus), and restricting daily protein to 0.8 g per kg body weight per day is essential to managing disease burden. […] Planning for Long-term Renal Replacement Therapy […] Early patient education should be initiated regarding natural disease progression, different modalities for dialysis, and renal transplantation. For patients in whom transplantation is not imminent, a primary arteriovenous fistula should be created in advance of the anticipated date of dialysis. Every patient with end-stage renal disease should be timely referred for renal transplantation.

• #16 Kidney Failure: Stages, ESRD, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17689-kidney-failure

  Kidney failure can worsen to the most severe stage, end-stage kidney disease (ESKD) which is deadly without treatment. If you have end-stage kidney disease, you may survive a few days or weeks without treatment. With the proper treatment, you can have a good quality of life while you manage kidney failure. […] If you’re in end-stage kidney failure, you need treatment to keep you alive. There are two main treatments for kidney failure: dialysis and a kidney transplant. […] Dialysis helps your body filter blood. You can think of it as giving your kidneys some relief, so they don’t have to work as hard to do their job. There are two types of dialysis: Hemodialysis and Peritoneal dialysis. […] A surgeon places a healthy kidney in your body during a kidney transplant to take over for your damaged kidney. The healthy kidney (donor organ) may come from a deceased donor or a living donor. […] With proper treatment, you can continue to live a happy, fulfilling life. But, you can expect to need treatment for the rest of your life. Remember, you can’t reverse kidney disease or kidney failure, you can only slow its progression.

• #17 End-Stage Renal Disease | Nutrition Guide for Clinicians

  https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342059/all/End_Stage_Renal_Disease

  Hemodialysis typically involves the surgical creation of an arteriovenous fistula (a connection between an artery and vein), usually in the forearm. […] Peritoneal dialysis involves inserting the dialysate into the patients abdomen and allowing dialysis to occur continuously or intermittently without requiring the patient to travel regularly to a dialysis center. […] Both methods have advantages and disadvantages, and outcomes are similar. […] Elderly patients with ESRD, often with other comorbidities, may fare better with conservative management compared with initiation of dialysis. Median life expectancy in these patients can range from 6-23 months in the absence of renal replacement therapy.

• #18 What Is End Stage Renal Disease – Also known as ESRD & ESKD

  https://www.freseniuskidneycare.com/thrive-central/what-is-end-stage-renal-disease

  If you’ve recently been diagnosed with end stage renal disease (ESRD), it’s important to know that there are treatment options that can help people thrive and live a full life. […] ESRD requires treatment to prolong life and keep you feeling healthy. […] You will discuss treatment options including: transplant, home peritoneal dialysis, home hemodialysis, and in-center hemodialysis. […] A kidney transplant is the best treatment option for providing natural kidney function and, therefore, generally the most effective treatment for ESRD. […] Dialysis is a life-sustaining treatment that takes the place of healthy kidney functions. Dialysis filters waste, toxins, and excess fluid from your body in place of your kidneys so you can live a full, productive life. […] There are 2 types of dialysis to choose from: Peritoneal dialysis (PD) naturally filters waste from your blood using blood vessels in the lining of your abdomen, called the peritoneum.

• #19 End-Stage Renal Disease | Nutrition Guide for Clinicians

  https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342059/all/End_Stage_Renal_Disease

  Hemodialysis typically involves the surgical creation of an arteriovenous fistula (a connection between an artery and vein), usually in the forearm. […] Peritoneal dialysis involves inserting the dialysate into the patients abdomen and allowing dialysis to occur continuously or intermittently without requiring the patient to travel regularly to a dialysis center. […] Both methods have advantages and disadvantages, and outcomes are similar. […] Elderly patients with ESRD, often with other comorbidities, may fare better with conservative management compared with initiation of dialysis. Median life expectancy in these patients can range from 6-23 months in the absence of renal replacement therapy.

• #20 ESRD Treatment Choices (ETC) Model | CMS

  https://www.cms.gov/priorities/innovation/innovation-models/esrd-treatment-choices-model

  Studies have shown that for patients who require dialysis, dialyzing at home is often preferred by patients and physicians. The benefits include increased independence and quality of life. […] Transplantation is widely viewed as the optimal treatment for most patients with ESRD, generally increasing survival and quality of life while reducing medical expenditures. […] One of the goals of the ETC Model is to give ESRD beneficiaries the freedom and choice of ESRD treatment that best works with their lifestyles. […] Under the ETC Model, CMS makes certain payment adjustments that encourage participating ESRD facilities and Managing Clinicians to ensure that ESRD beneficiaries have access to and receive education about and have access to their kidney disease treatment options. […] The model requires the Medicare payment adjustments for selected ESRD facilities and Managing Clinicians.

• #21 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  End-stage renal disease (ESRD) is diagnosed when kidney function is no longer adequate for long-term survival without kidney transplantation or dialysis. […] Kidney transplantation typically yields the best patient outcomes, although most patients are treated with dialysis. […] A palliative approach to ESRD is a reasonable alternative to dialysis, particularly for individuals with limited life expectancy, with severe comorbid conditions, or who wish to avoid medical interventions. […] Insulin is the preferred treatment for patients with ESRD and diabetes mellitus requiring medication. […] Most patients elect to receive dialysis to treat their ESRD, and these patients tend to live longer than those choosing conservative management. […] Patients with ESRD can elect a palliative approach to managing their disease that does not involve dialysis. This approach emphasizes quality of life over the prolongation of life.

• #22 End-Stage Renal Disease: Medical Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/34783494/

  End-stage renal disease (ESRD) is diagnosed when kidney function is no longer adequate for long-term survival without kidney transplantation or dialysis. […] Kidney transplantation typically yields the best patient outcomes, although most patients are treated with dialysis. […] A palliative approach to ESRD is a reasonable alternative to dialysis, particularly for individuals with limited life expectancy, with severe comorbid conditions, or who wish to avoid medical interventions. […] Controlling blood pressure in patients receiving dialysis improves mortality. […] Insulin is the preferred treatment for patients with ESRD and diabetes mellitus requiring medication. […] Clinicians must be aware of the many medical complications associated with ESRD.

• #23 Chronic kidney disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/diagnosis-treatment/drc-20354527

  During kidney transplant surgery, the donor kidney is placed in your lower abdomen. Blood vessels of the new kidney are attached to blood vessels in the lower part of your abdomen, just above one of your legs. The new kidney’s urine tube (ureter) is connected to your bladder. Unless they are causing complications, your own kidneys are left in place. […] Depending on the cause, some types of kidney disease can be treated. Often, though, chronic kidney disease has no cure. […] Treatment usually consists of measures to help control signs and symptoms, reduce complications, and slow progression of the disease. If your kidneys become severely damaged, you might need treatment for end-stage kidney disease. […] If your kidneys can’t keep up with waste and fluid clearance on their own and you develop complete or near-complete kidney failure, you have end-stage kidney disease. At that point, you need dialysis or a kidney transplant.

• #24 Chronic kidney disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/diagnosis-treatment/drc-20354527

  During kidney transplant surgery, the donor kidney is placed in your lower abdomen. Blood vessels of the new kidney are attached to blood vessels in the lower part of your abdomen, just above one of your legs. The new kidney’s urine tube (ureter) is connected to your bladder. Unless they are causing complications, your own kidneys are left in place. […] Depending on the cause, some types of kidney disease can be treated. Often, though, chronic kidney disease has no cure. […] Treatment usually consists of measures to help control signs and symptoms, reduce complications, and slow progression of the disease. If your kidneys become severely damaged, you might need treatment for end-stage kidney disease. […] If your kidneys can’t keep up with waste and fluid clearance on their own and you develop complete or near-complete kidney failure, you have end-stage kidney disease. At that point, you need dialysis or a kidney transplant.

• #25 Kidney Failure: Stages, ESRD, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17689-kidney-failure

  Kidney failure can worsen to the most severe stage, end-stage kidney disease (ESKD) which is deadly without treatment. If you have end-stage kidney disease, you may survive a few days or weeks without treatment. With the proper treatment, you can have a good quality of life while you manage kidney failure. […] If you’re in end-stage kidney failure, you need treatment to keep you alive. There are two main treatments for kidney failure: dialysis and a kidney transplant. […] Dialysis helps your body filter blood. You can think of it as giving your kidneys some relief, so they don’t have to work as hard to do their job. There are two types of dialysis: Hemodialysis and Peritoneal dialysis. […] A surgeon places a healthy kidney in your body during a kidney transplant to take over for your damaged kidney. The healthy kidney (donor organ) may come from a deceased donor or a living donor. […] With proper treatment, you can continue to live a happy, fulfilling life. But, you can expect to need treatment for the rest of your life. Remember, you can’t reverse kidney disease or kidney failure, you can only slow its progression.

• #26 Kidney failure (ESRD) – Symptoms, causes and treatment options | American Kidney Fund

  https://www.kidneyfund.org/all-about-kidneys/kidney-failure-symptoms-and-causes

  Kidney failure, also called end-stage renal disease (ESRD) or end-stage kidney disease (ESKD), is the fifth and last stage of chronic kidney disease (CKD). Kidney failure cannot be reversed and is life-threatening if left untreated. However, dialysis or a kidney transplant can help you live for many more years. […] You will need to see a nephrologist (kidney doctor). Your nephrologist will talk with you about your treatment choices, which include: […] Dialysis, which is a treatment that uses a machine to clean your blood […] A kidney transplant: […] Deceased donor kidney transplant, which is a surgery to give you a healthy kidney from someone who has just died […] Living donor kidney transplant, which is a surgery to give you a healthy kidney from someone who is still alive. […] When your kidneys fail, they cannot get better. Your life expectancy depends on many things, including your age. However, treatment can help people with kidney failure live for many more years:

• #27 Kidney failure (ESRD) – Symptoms, causes and treatment options | American Kidney Fund

  https://www.kidneyfund.org/all-about-kidneys/kidney-failure-symptoms-and-causes

  Dialysis helps people live for another five to 10 years on average. […] Deceased donor kidney transplants last 10 to 15 years on average. […] Living kidney donor transplants last 15 to 20 years on average. […] If you choose not to get treatment for kidney failure, you can get medical management. This is supportive care and treatment to relieve your symptoms, but it will not keep you alive. There is no way to know how long you will live if you choose medical management. Your doctor will help you stay as healthy as possible.

• #28 Chronic kidney disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/diagnosis-treatment/drc-20354527

  Dialysis artificially removes waste products and extra fluid from your blood when your kidneys can no longer do this. In hemodialysis, a machine filters waste and excess fluids from your blood. […] A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors. […] After a transplant, you’ll need to take medications for the rest of your life to keep your body from rejecting the new organ. You don’t need to be on dialysis to have a kidney transplant. […] For some who choose not to have dialysis or a kidney transplant, a third option is to treat your kidney failure with conservative measures. Conservative measures likely will include symptom management, advance care planning and care to keep you comfortable (palliative care).

• #29 Treatments for kidney disease – AKF

  https://www.kidneyfund.org/treatment-kidney-failure

  When you have kidney failure (also called end-stage renal disease, or ESRD), it means your kidneys have stopped working well enough for you to live without treatment. There is no cure for kidney failure, but with treatment many people with kidney failure are able to keep doing activities they want or need to do. […] You will need dialysis when you have kidney failure, also called end stage renal disease (ESRD). Kidney failure means your own kidneys no longer take care of your body’s needs to remove waste or extra fluids from your blood. […] A kidney transplant is not a cure, but a treatment for kidney failure. […] Medical management is not a treatment for kidney failure and it will not keep you alive.

• #30 End-Stage Renal Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499861/

  Every patient with end-stage renal disease should be timely referred for renal transplantation. […] Indications for renal replacement therapy in patients with CKD include the following: Severe metabolic acidosis, Hyperkalemia, Pericarditis, Encephalopathy, Intractable volume overload, Failure to thrive and malnutrition, Peripheral neuropathy, Intractable gastrointestinal symptoms, Glomerular filtration rate (GFR) of 5 to 9 mL/min/1.73 m^2, irrespective of the symptoms or the presence or absence of other comorbidities. […] There is no cure for end-stage renal disease, and all the available treatments are short-term. Thus, the key to improving long-term outcomes is preventing the disease’s progression.

• #31 End-Stage Renal Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21081

  Indications for renal replacement therapy in patients with CKD include the following: Severe metabolic acidosis, Hyperkalemia, Pericarditis, Encephalopathy, Intractable volume overload, Failure to thrive and malnutrition, Peripheral neuropathy, Intractable gastrointestinal symptoms, Glomerular filtration rate (GFR) of 5 to 9 mL/min/1.73 m^2, irrespective of the symptoms or the presence or absence of other comorbidities.

• #32 Chronic Kidney Disease (CKD) Treatment & Management: Approach Considerations, Delaying or Halting Progression of Chronic Kidney Disease, Treating Pathologic Manifestations of Chronic Kidney Disease

  https://emedicine.medscape.com/article/238798-treatment

  Early diagnosis and treatment of the underlying cause and/or the institution of secondary preventive measures are imperative in patients with chronic kidney disease (CKD). These steps may delay, or possibly halt, progression of the disease. Early referral to a nephrologist is of extreme importance. […] The medical care of patients with CKD should focus on the following: Delaying or halting the progression of CKD, Diagnosing and treating the pathologic manifestations of CKD, Timely planning for long-term renal replacement therapy. […] In 2014, the Canadian Society of Nephrology released guidelines that recommend delaying dialysis in CKD patients without symptoms until their estimated glomerular filtration rate (eGFR) drops to 6 mL/min/1.73 m2 or until the first onset of a clinical indication (which includes uremia, fluid overload, and refractory hyperkalemia or acidemia).

• #33 Kidney failure (ESRD) – Symptoms, stages, & treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/kidney-failure

  Kidney transplant: A kidney transplant is an operation that places a healthy kidney in your body. […] Conservative management focuses on your quality of life and managing symptoms without dialysis or a kidney transplant. Conservative management is also called comfort care, non-dialytic care, supportive care, or comprehensive conservative care. […] There are many things to consider when choosing a treatment for kidney failure, including lifestyle, health problems or the need for someone to assist you. Your decision should be based on your medical history, a healthcare professionals opinion, and on what you and your family want. Learning about your treatment choices will help you decide which is best for you.

• #34 End Stage Renal Disease – Treatment Options: Dialysis Versus Transplant | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-00132-2_2

  Treatment option for patients with end stage renal disease (ESRD) include dialysis and kidney transplantation. […] Kidney transplantation is considered to be the preferred method of treatment for patients with ESRD. […] Compared to ESRD a patient after kidney transplantation lives longer, has better quality of life and incurs fewer costs. […] Also, certain parameters of chronic kidney disease (CKD) are better managed, or even halted, after Kidney transplantation include anemia, calcium phosphorus metabolism, and vascular calcification and undesired effects of Kidney transplantation include increased risk of infections, malignancy, fractures, obesity. […] Although mortality is significantly improved after kidney transplantation compared to dialysis but still transplant recipients carry 23 times higher mortality risk than general population. […] Proper management and appropriate preventive health measures may improve long term patient and allograft survival.

• #35 Kidney failure (ESRD) – Symptoms, causes and treatment options | American Kidney Fund

  https://www.kidneyfund.org/all-about-kidneys/kidney-failure-symptoms-and-causes

  Dialysis helps people live for another five to 10 years on average. […] Deceased donor kidney transplants last 10 to 15 years on average. […] Living kidney donor transplants last 15 to 20 years on average. […] If you choose not to get treatment for kidney failure, you can get medical management. This is supportive care and treatment to relieve your symptoms, but it will not keep you alive. There is no way to know how long you will live if you choose medical management. Your doctor will help you stay as healthy as possible.

• #36

  https://www.nhs.uk/conditions/kidney-disease/treatment/

  There’s no cure for chronic kidney disease (CKD), but treatment can help relieve the symptoms and stop it getting worse. […] The main treatments are: […] dialysis treatment to replicate some of the kidney’s functions, which may be necessary in advanced (stage 5) CKD […] kidney transplant this may also be necessary in advanced (stage 5) CKD. […] For a small proportion of people with CKD, the kidneys will eventually stop working. […] One of the options when CKD reaches this stage is dialysis. This is a method of removing waste products and excess fluid from the blood. […] An alternative to dialysis for people with severely reduced kidney function is a kidney transplant. […] Survival rates for kidney transplants are very good. About 90% of transplants still function after 5 years and many work usefully after 10 years or more. […] You’ll be offered supportive treatment if you decide not to have dialysis or a transplant for kidney failure, or they’re not suitable for you. This is also called palliative or conservative care. […] The aim is to treat and control the symptoms of kidney failure.

• #37 End Stage Renal Disease – Treatment Options: Dialysis Versus Transplant | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-00132-2_2

  Treatment option for patients with end stage renal disease (ESRD) include dialysis and kidney transplantation. […] Kidney transplantation is considered to be the preferred method of treatment for patients with ESRD. […] Compared to ESRD a patient after kidney transplantation lives longer, has better quality of life and incurs fewer costs. […] Also, certain parameters of chronic kidney disease (CKD) are better managed, or even halted, after Kidney transplantation include anemia, calcium phosphorus metabolism, and vascular calcification and undesired effects of Kidney transplantation include increased risk of infections, malignancy, fractures, obesity. […] Although mortality is significantly improved after kidney transplantation compared to dialysis but still transplant recipients carry 23 times higher mortality risk than general population. […] Proper management and appropriate preventive health measures may improve long term patient and allograft survival.

• #38 Kidney failure (ESRD) – Symptoms, causes and treatment options | American Kidney Fund

  https://www.kidneyfund.org/all-about-kidneys/kidney-failure-symptoms-and-causes

  Dialysis helps people live for another five to 10 years on average. […] Deceased donor kidney transplants last 10 to 15 years on average. […] Living kidney donor transplants last 15 to 20 years on average. […] If you choose not to get treatment for kidney failure, you can get medical management. This is supportive care and treatment to relieve your symptoms, but it will not keep you alive. There is no way to know how long you will live if you choose medical management. Your doctor will help you stay as healthy as possible.

• #39 Dialysis – Types, effectiveness, side effects | National Kidney Foundation

  https://www.kidney.org/kidney-topics/dialysis

  Dialysis is a very effective treatment option for clearing waste products and extra fluid from your blood. However, it does not fully replace all the kidneys functions, so it is not considered a cure for kidney disease or kidney failure. […] Life expectancy on dialysis varies depending on your other medical conditions, how well you follow your treatment plan, and various other factors. The average life expectancy on dialysis is 5-10 years. However, many patients have lived well on dialysis for 20 or even 30 years. Talk to your healthcare team about how to take care of yourself and stay healthy on dialysis.

• #40 ESRD Treatment Choices (ETC) Model | CMS

  https://www.cms.gov/priorities/innovation/innovation-models/esrd-treatment-choices-model

  Studies have shown that for patients who require dialysis, dialyzing at home is often preferred by patients and physicians. The benefits include increased independence and quality of life. […] Transplantation is widely viewed as the optimal treatment for most patients with ESRD, generally increasing survival and quality of life while reducing medical expenditures. […] One of the goals of the ETC Model is to give ESRD beneficiaries the freedom and choice of ESRD treatment that best works with their lifestyles. […] Under the ETC Model, CMS makes certain payment adjustments that encourage participating ESRD facilities and Managing Clinicians to ensure that ESRD beneficiaries have access to and receive education about and have access to their kidney disease treatment options. […] The model requires the Medicare payment adjustments for selected ESRD facilities and Managing Clinicians.

• #41 Dialysis and Beyond Navigating Treatment Options for End-Stage Renal Disease – Associates in Nephrology, PC

  https://www.associatesinnephrologypc.com/2023/10/06/dialysis-and-beyond-navigating-treatment-options-for-end-stage-renal-disease/

  People who choose not to have dialysis or kidney transplants can have palliative or supportive care to manage their symptoms and feel better. Palliative care can also be combined with dialysis or kidney transplants. Without dialysis or kidney transplant, kidney failure progresses and leads to death. […] Navigating your treatment options for end-stage renal disease can be overwhelming. Therefore, it is important to consult a kidney specialist for a comprehensive medical evaluation to choose the right treatment options for you. […] The patient’s health status is a critical factor that influences the choice of treatment for end-stage renal disease. […] Long-term outlook refers to the expected course and outcome of the medical condition over an extended period. […] Compared to long-term dialysis, kidney transplants offer the potential for longer and better quality of life.

• #42 Comparing Treatment Modalities for End-Stage Renal Disease: A Meta-Analysis

  https://www.ahdbonline.com/issues/2018/may-2018-vol-11-no-3/2575-comparing-treatment-modalities-for-end-stage-renal-disease-a-meta-analysis

  A total of 15 studies with a combined sample size of 4318 patients met the study criteria and were included in the analysis. The pooled effect sizes based on the random-effects model were 0.24 (95% confidence interval [CI], 0.17-0.66) in the general domain; 0.10 (95% CI, 0.09-0.29) in the physical functioning domain; and 0.29 (95% CI, 0.13-0.71) in the psychological-functioning domain. None of the summary effect sizes was statistically significant. Subgroup analyses favored peritoneal dialysis regarding the time and country of publication. […] The majority of the studies included in this analysis favored peritoneal dialysis over hemodialysis in all 3 domains. However, the pooled effect sizes were not significant, resulting in the inability to conclude that peritoneal dialysis is the more effective of these 2 treatment modalities.

• #43 Comparing Treatment Modalities for End-Stage Renal Disease: A Meta-Analysis

  https://www.ahdbonline.com/issues/2018/may-2018-vol-11-no-3/2575-comparing-treatment-modalities-for-end-stage-renal-disease-a-meta-analysis

  When contrasting peritoneal dialysis with hemodialysis, a majority of studies suggested that peritoneal dialysis had a more favorable impact across all 3 domains of HRQoL. However, summary effect sizes from the meta-analysis indicated significant variation based on time of publication and study location (non-US studies were recent and favored peritoneal dialysis; US studies were older, larger, and nominally favored hemodialysis). Aggregate results, therefore, did not permit conclusions regarding peritoneal dialysis versus hemodialysis impact on HRQoL.

• #44 ESRD Treatment Choices (ETC) Model | CMS

  https://www.cms.gov/priorities/innovation/innovation-models/esrd-treatment-choices-model

  The End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model is a mandatory model intended to encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD, while reducing Medicare expenditures and preserving or enhancing the quality of care furnished to beneficiaries with ESRD. […] Many patients with end-stage renal disease do not receive education about their treatment options, including the choice to get dialysis at home rather than at a center or the possibility of a kidney transplant. Both these treatment options are known to offer patients increased quality of life. […] The goal of the ESRD Treatment Choices (ETC) Model is for patients to have greater independence and flexibility by receiving home dialysis and have longer, healthier lives resulting from a kidney transplant.

• #45 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  End-stage renal disease (ESRD) is diagnosed when kidney function is no longer adequate for long-term survival without kidney transplantation or dialysis. […] Kidney transplantation typically yields the best patient outcomes, although most patients are treated with dialysis. […] A palliative approach to ESRD is a reasonable alternative to dialysis, particularly for individuals with limited life expectancy, with severe comorbid conditions, or who wish to avoid medical interventions. […] Insulin is the preferred treatment for patients with ESRD and diabetes mellitus requiring medication. […] Most patients elect to receive dialysis to treat their ESRD, and these patients tend to live longer than those choosing conservative management. […] Patients with ESRD can elect a palliative approach to managing their disease that does not involve dialysis. This approach emphasizes quality of life over the prolongation of life.

• #46 Kidney failure (ESRD) – Symptoms, stages, & treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/kidney-failure

  Kidney transplant: A kidney transplant is an operation that places a healthy kidney in your body. […] Conservative management focuses on your quality of life and managing symptoms without dialysis or a kidney transplant. Conservative management is also called comfort care, non-dialytic care, supportive care, or comprehensive conservative care. […] There are many things to consider when choosing a treatment for kidney failure, including lifestyle, health problems or the need for someone to assist you. Your decision should be based on your medical history, a healthcare professionals opinion, and on what you and your family want. Learning about your treatment choices will help you decide which is best for you.

• #47 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  End-stage renal disease (ESRD) is diagnosed when kidney function is no longer adequate for long-term survival without kidney transplantation or dialysis. […] Kidney transplantation typically yields the best patient outcomes, although most patients are treated with dialysis. […] A palliative approach to ESRD is a reasonable alternative to dialysis, particularly for individuals with limited life expectancy, with severe comorbid conditions, or who wish to avoid medical interventions. […] Insulin is the preferred treatment for patients with ESRD and diabetes mellitus requiring medication. […] Most patients elect to receive dialysis to treat their ESRD, and these patients tend to live longer than those choosing conservative management. […] Patients with ESRD can elect a palliative approach to managing their disease that does not involve dialysis. This approach emphasizes quality of life over the prolongation of life.

• #48 End-stage kidney disease: The last 12 months

  https://www1.racgp.org.au/ajgp/2021/april/end-stage-kidney-disease-the-last-12-months-1

  The decision to manage ESKD conservatively may be reached by patient consultation with a nephrologist, geriatrician or general practitioner. […] Conservative management should not be viewed as abandonment or substandard care. It may mean that elderly patients avoid the suffering that can come from dialysis in some cases. […] The trajectory of ESKD that is conservatively managed is often one of relatively preserved functional status until late in the course of illness, which is characterised by a rapid decline towards death. […] Although the patient is not undergoing dialysis, the nephrologist should continue to care for their conservatively managed patients. No dialysis does not mean no treatment, and it is important to emphasise this to the patient and their family. […] Advance care planning is a process of communication, understanding, and discussion between a patient, their caregivers and healthcare providers, with the goal of clarifying values and preferences for future care, including care at the end of life. […] An advance care plan for a patient with ESKD should include a preference to avoid invasive treatments such as intubation and cardiopulmonary resuscitation; instructions regarding initiation, withholding and/or withdrawal of dialysis; and preferred place of death.

• #49 End-stage kidney disease: The last 12 months

  https://www1.racgp.org.au/ajgp/2021/april/end-stage-kidney-disease-the-last-12-months-1

  The decision to manage ESKD conservatively may be reached by patient consultation with a nephrologist, geriatrician or general practitioner. […] Conservative management should not be viewed as abandonment or substandard care. It may mean that elderly patients avoid the suffering that can come from dialysis in some cases. […] The trajectory of ESKD that is conservatively managed is often one of relatively preserved functional status until late in the course of illness, which is characterised by a rapid decline towards death. […] Although the patient is not undergoing dialysis, the nephrologist should continue to care for their conservatively managed patients. No dialysis does not mean no treatment, and it is important to emphasise this to the patient and their family. […] Advance care planning is a process of communication, understanding, and discussion between a patient, their caregivers and healthcare providers, with the goal of clarifying values and preferences for future care, including care at the end of life. […] An advance care plan for a patient with ESKD should include a preference to avoid invasive treatments such as intubation and cardiopulmonary resuscitation; instructions regarding initiation, withholding and/or withdrawal of dialysis; and preferred place of death.

• #50 End-Stage Renal Disease: Symptom Management and Advance Care Planning | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p705.html

  The prevalence of end-stage renal disease continues to increase, and dialysis is offered to older and more medically complex patients. […] Fentanyl and methadone are considered the safest opioids for use in patients with end-stage renal disease. […] Nondialytic management may be preferable to dialysis initiation in older patients and in those with additional life-limiting illnesses, and may not significantly decrease life expectancy. […] Patients with end-stage renal disease should have advance directives, including documentation of situations in which they would no longer want dialysis. […] Conservative (nondialytic) management of end-stage renal disease can be offered to older adults and patients with multiple comorbidities. […] Delayed initiation of dialysis (when glomerular filtration rate is 5.0 to 7.0 mL per minute per 1.73 m2) yields equivalent outcomes to early initiation.

• #51 End-Stage Renal Disease: Symptom Management and Advance Care Planning | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p705.html

  Family physicians can counsel older patients and those with multiple comorbidities that nondialytic management is a viable option in end-stage renal disease. […] Delayed dialysis initiation is an acceptable option, especially in patients who are unsure that they want dialysis. […] Advance directives (i.e., a living will and durable power of attorney for health care) can guide physicians in end-of-life decision making. […] Withdrawal of dialysis is common in end-stage renal disease; therefore, disease-specific advance directives that include dialysis withdrawal have been proposed.

• #52 End-Stage Renal Disease: Symptom Management and Advance Care Planning | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p705.html

  The prevalence of end-stage renal disease continues to increase, and dialysis is offered to older and more medically complex patients. […] Fentanyl and methadone are considered the safest opioids for use in patients with end-stage renal disease. […] Nondialytic management may be preferable to dialysis initiation in older patients and in those with additional life-limiting illnesses, and may not significantly decrease life expectancy. […] Patients with end-stage renal disease should have advance directives, including documentation of situations in which they would no longer want dialysis. […] Conservative (nondialytic) management of end-stage renal disease can be offered to older adults and patients with multiple comorbidities. […] Delayed initiation of dialysis (when glomerular filtration rate is 5.0 to 7.0 mL per minute per 1.73 m2) yields equivalent outcomes to early initiation.

• #53 End-stage kidney disease: The last 12 months

  https://www1.racgp.org.au/ajgp/2021/april/end-stage-kidney-disease-the-last-12-months-1

  The decision to manage ESKD conservatively may be reached by patient consultation with a nephrologist, geriatrician or general practitioner. […] Conservative management should not be viewed as abandonment or substandard care. It may mean that elderly patients avoid the suffering that can come from dialysis in some cases. […] The trajectory of ESKD that is conservatively managed is often one of relatively preserved functional status until late in the course of illness, which is characterised by a rapid decline towards death. […] Although the patient is not undergoing dialysis, the nephrologist should continue to care for their conservatively managed patients. No dialysis does not mean no treatment, and it is important to emphasise this to the patient and their family. […] Advance care planning is a process of communication, understanding, and discussion between a patient, their caregivers and healthcare providers, with the goal of clarifying values and preferences for future care, including care at the end of life. […] An advance care plan for a patient with ESKD should include a preference to avoid invasive treatments such as intubation and cardiopulmonary resuscitation; instructions regarding initiation, withholding and/or withdrawal of dialysis; and preferred place of death.

• #54 End-stage kidney disease: The last 12 months

  https://www1.racgp.org.au/ajgp/2021/april/end-stage-kidney-disease-the-last-12-months-1

  The decision to manage ESKD conservatively may be reached by patient consultation with a nephrologist, geriatrician or general practitioner. […] Conservative management should not be viewed as abandonment or substandard care. It may mean that elderly patients avoid the suffering that can come from dialysis in some cases. […] The trajectory of ESKD that is conservatively managed is often one of relatively preserved functional status until late in the course of illness, which is characterised by a rapid decline towards death. […] Although the patient is not undergoing dialysis, the nephrologist should continue to care for their conservatively managed patients. No dialysis does not mean no treatment, and it is important to emphasise this to the patient and their family. […] Advance care planning is a process of communication, understanding, and discussion between a patient, their caregivers and healthcare providers, with the goal of clarifying values and preferences for future care, including care at the end of life. […] An advance care plan for a patient with ESKD should include a preference to avoid invasive treatments such as intubation and cardiopulmonary resuscitation; instructions regarding initiation, withholding and/or withdrawal of dialysis; and preferred place of death.

• #55 Chronic Kidney Disease (CKD) Treatment & Management: Approach Considerations, Delaying or Halting Progression of Chronic Kidney Disease, Treating Pathologic Manifestations of Chronic Kidney Disease

  https://emedicine.medscape.com/article/238798-treatment

  In January 2025 the FDA approved the GLP-1 agonist semaglutide (Ozempic) to reduce the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes mellitus and CKD. […] Treat these pathologic manifestations of CKD as follows: Anemia When the hemoglobin level is below 10 g/dL, treat with an erythropoiesis-stimulating agent, Hyperphosphatemia Treat with dietary phosphate binders, dietary phosphate restriction, and sodium/hydrogen exchanger 3 (NHE3) inhibitors, Hypocalcemia Treat with calcium supplements with or without calcitriol, Hyperparathyroidism Treat with calcitriol, vitamin D analogues, or calcimimetics, Volume overload Treat with loop diuretics or ultrafiltration, Metabolic acidosis Treat with oral alkali supplementation, Uremic manifestations Treat with long-term renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplantation).

• #56 Common Drugs Prescribed for Dialysis Patients – DaVita

  http://www.davita.com/treatment-services/prescription/common-drugs-prescribed-for-dialysis-patients

  Nearly all patients with end stage renal disease (ESRD) who are on dialysis, have anemia. […] Most patients with renal failure on hemodialysis will get erythropoietin during each treatment by intravenous injection into the return dialysis tubing. […] Most dialysis patients need to receive iron. […] The oral form of active vitamin D may be effective in preventing high PTH. […] Preventing or reversing this process can be done through diet and medicines such as phosphorus binders. […] Most nephrologists feel that the use of a B-complex vitamin along with folic acid is a good protection for when patients don’t have an appetite. […] High dose folic acid therapy is being evaluated as a possible preventative treatment in dialysis patients. […] Vitamin E has been said to help many people as a preventative measure for cramps when taken either before dialysis or at bedtime. […] People with CKD, as well as those on dialysis, need to be involved in all areas of their care.

• #57 Chronic Kidney Disease (CKD) Treatment & Management: Approach Considerations, Delaying or Halting Progression of Chronic Kidney Disease, Treating Pathologic Manifestations of Chronic Kidney Disease

  https://emedicine.medscape.com/article/238798-treatment

  In January 2025 the FDA approved the GLP-1 agonist semaglutide (Ozempic) to reduce the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes mellitus and CKD. […] Treat these pathologic manifestations of CKD as follows: Anemia When the hemoglobin level is below 10 g/dL, treat with an erythropoiesis-stimulating agent, Hyperphosphatemia Treat with dietary phosphate binders, dietary phosphate restriction, and sodium/hydrogen exchanger 3 (NHE3) inhibitors, Hypocalcemia Treat with calcium supplements with or without calcitriol, Hyperparathyroidism Treat with calcitriol, vitamin D analogues, or calcimimetics, Volume overload Treat with loop diuretics or ultrafiltration, Metabolic acidosis Treat with oral alkali supplementation, Uremic manifestations Treat with long-term renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplantation).

• #58 Common Drugs Prescribed for Dialysis Patients – DaVita

  http://www.davita.com/treatment-services/prescription/common-drugs-prescribed-for-dialysis-patients

  Nearly all patients with end stage renal disease (ESRD) who are on dialysis, have anemia. […] Most patients with renal failure on hemodialysis will get erythropoietin during each treatment by intravenous injection into the return dialysis tubing. […] Most dialysis patients need to receive iron. […] The oral form of active vitamin D may be effective in preventing high PTH. […] Preventing or reversing this process can be done through diet and medicines such as phosphorus binders. […] Most nephrologists feel that the use of a B-complex vitamin along with folic acid is a good protection for when patients don’t have an appetite. […] High dose folic acid therapy is being evaluated as a possible preventative treatment in dialysis patients. […] Vitamin E has been said to help many people as a preventative measure for cramps when taken either before dialysis or at bedtime. […] People with CKD, as well as those on dialysis, need to be involved in all areas of their care.

• #59 Common Drugs Prescribed for Dialysis Patients – DaVita

  http://www.davita.com/treatment-services/prescription/common-drugs-prescribed-for-dialysis-patients

  Nearly all patients with end stage renal disease (ESRD) who are on dialysis, have anemia. […] Most patients with renal failure on hemodialysis will get erythropoietin during each treatment by intravenous injection into the return dialysis tubing. […] Most dialysis patients need to receive iron. […] The oral form of active vitamin D may be effective in preventing high PTH. […] Preventing or reversing this process can be done through diet and medicines such as phosphorus binders. […] Most nephrologists feel that the use of a B-complex vitamin along with folic acid is a good protection for when patients don’t have an appetite. […] High dose folic acid therapy is being evaluated as a possible preventative treatment in dialysis patients. […] Vitamin E has been said to help many people as a preventative measure for cramps when taken either before dialysis or at bedtime. […] People with CKD, as well as those on dialysis, need to be involved in all areas of their care.

• #60 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  FF #408 Conservative Management of Patients With End Stage Renal Disease […] Background ESRD describes advanced kidney failure (typically a glomerular filtration rate < 15 ml/min/m2) and is the point at which many patients start dialysis if they cannot receive a kidney transplant. Conservative management (CM) refers to the management of the symptoms and signs of ESRD in patients who do not receive dialysis or transplantation, whether due to personal preference or comorbidities (e.g., dementia, advanced frailty). Significant symptom burden is common in patients with ESRD nearing the end-of life, including those receiving CM (1). [...] Lack of energy Depression (see Fast Fact #404), volume imbalance, sleep disorders, poor nutrition, and anemia are common underlying causes of fatigue in patients with ESRD. Blood transfusions have been shown to improve fatigue and self-reported well-being for palliative care patients who are anemic (2). Erythropoietin-stimulating agents are transfusion-sparing interventions that can similarly mitigate fatigue and enhance quality of life for select ESRD patients on CM (3). Psychostimulants do not have supporting evidence in the CKD population and may cause anorexigenic and cardiovascular effects (4).

• #61 Chronic Kidney Disease (CKD) Treatment & Management: Approach Considerations, Delaying or Halting Progression of Chronic Kidney Disease, Treating Pathologic Manifestations of Chronic Kidney Disease

  https://emedicine.medscape.com/article/238798-treatment

  In January 2025 the FDA approved the GLP-1 agonist semaglutide (Ozempic) to reduce the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes mellitus and CKD. […] Treat these pathologic manifestations of CKD as follows: Anemia When the hemoglobin level is below 10 g/dL, treat with an erythropoiesis-stimulating agent, Hyperphosphatemia Treat with dietary phosphate binders, dietary phosphate restriction, and sodium/hydrogen exchanger 3 (NHE3) inhibitors, Hypocalcemia Treat with calcium supplements with or without calcitriol, Hyperparathyroidism Treat with calcitriol, vitamin D analogues, or calcimimetics, Volume overload Treat with loop diuretics or ultrafiltration, Metabolic acidosis Treat with oral alkali supplementation, Uremic manifestations Treat with long-term renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplantation).

• #62 End-Stage Renal Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21081

  Hyperphosphatemia is treated with phosphate binders (calcium acetate, sevelamer carbonate, or lanthanum carbonate) and dietary phosphate restriction. […] Lifestyle modification and dietary restrictions are routinely recommended. For example, adhering to a low salt diet (less than 2 g/day), a renal diet (avoiding foods that are high in phosphorus), and restricting daily protein to 0.8 g per kg body weight per day is essential to managing disease burden. […] Planning for Long-term Renal Replacement Therapy […] Early patient education should be initiated regarding natural disease progression, different modalities for dialysis, and renal transplantation. For patients in whom transplantation is not imminent, a primary arteriovenous fistula should be created in advance of the anticipated date of dialysis. Every patient with end-stage renal disease should be timely referred for renal transplantation.

• #63 Chronic Kidney Disease (CKD) Treatment & Management: Approach Considerations, Delaying or Halting Progression of Chronic Kidney Disease, Treating Pathologic Manifestations of Chronic Kidney Disease

  https://emedicine.medscape.com/article/238798-treatment

  In January 2025 the FDA approved the GLP-1 agonist semaglutide (Ozempic) to reduce the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes mellitus and CKD. […] Treat these pathologic manifestations of CKD as follows: Anemia When the hemoglobin level is below 10 g/dL, treat with an erythropoiesis-stimulating agent, Hyperphosphatemia Treat with dietary phosphate binders, dietary phosphate restriction, and sodium/hydrogen exchanger 3 (NHE3) inhibitors, Hypocalcemia Treat with calcium supplements with or without calcitriol, Hyperparathyroidism Treat with calcitriol, vitamin D analogues, or calcimimetics, Volume overload Treat with loop diuretics or ultrafiltration, Metabolic acidosis Treat with oral alkali supplementation, Uremic manifestations Treat with long-term renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplantation).

• #64 Chronic Kidney Disease (CKD) Treatment & Management: Approach Considerations, Delaying or Halting Progression of Chronic Kidney Disease, Treating Pathologic Manifestations of Chronic Kidney Disease

  https://emedicine.medscape.com/article/238798-treatment

  In January 2025 the FDA approved the GLP-1 agonist semaglutide (Ozempic) to reduce the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes mellitus and CKD. […] Treat these pathologic manifestations of CKD as follows: Anemia When the hemoglobin level is below 10 g/dL, treat with an erythropoiesis-stimulating agent, Hyperphosphatemia Treat with dietary phosphate binders, dietary phosphate restriction, and sodium/hydrogen exchanger 3 (NHE3) inhibitors, Hypocalcemia Treat with calcium supplements with or without calcitriol, Hyperparathyroidism Treat with calcitriol, vitamin D analogues, or calcimimetics, Volume overload Treat with loop diuretics or ultrafiltration, Metabolic acidosis Treat with oral alkali supplementation, Uremic manifestations Treat with long-term renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplantation).

• #65 Common Drugs Prescribed for Dialysis Patients – DaVita

  http://www.davita.com/treatment-services/prescription/common-drugs-prescribed-for-dialysis-patients

  Nearly all patients with end stage renal disease (ESRD) who are on dialysis, have anemia. […] Most patients with renal failure on hemodialysis will get erythropoietin during each treatment by intravenous injection into the return dialysis tubing. […] Most dialysis patients need to receive iron. […] The oral form of active vitamin D may be effective in preventing high PTH. […] Preventing or reversing this process can be done through diet and medicines such as phosphorus binders. […] Most nephrologists feel that the use of a B-complex vitamin along with folic acid is a good protection for when patients don’t have an appetite. […] High dose folic acid therapy is being evaluated as a possible preventative treatment in dialysis patients. […] Vitamin E has been said to help many people as a preventative measure for cramps when taken either before dialysis or at bedtime. […] People with CKD, as well as those on dialysis, need to be involved in all areas of their care.

• #66 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  GI symptoms Renally-dosed haloperidol is a prudent initial step for nausea management, as it may improve other terminal symptoms in patients with ESRD such as agitation (19). Ondansetron and metoclopramide can be considered as well. The diet should be liberalized, despite metabolic concerns. Dysgeusia and anorexia should be assessed regularly. See Fast Facts # 100, 304, and 314 […] Pharmacologic considerations Other interventions that can address electrolyte or acid-base derangements which can potentially cause distressing pain, cramping, or weakness should be discussed with the patient. These include therapies for hyperkalemia, acidemia, and mineral bone disease. Stopping blood pressure medications such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ACE/ARB) is recommended as tight blood pressure control only conveys long-term benefits and elevated blood pressure is rarely symptomatic. ACE/ARBs also pose risks of hyperkalemia and symptomatic hypotension complicated by dizziness and falls.

• #67 Chronic Kidney Disease (CKD) Treatment & Management: Approach Considerations, Delaying or Halting Progression of Chronic Kidney Disease, Treating Pathologic Manifestations of Chronic Kidney Disease

  https://emedicine.medscape.com/article/238798-treatment

  In January 2025 the FDA approved the GLP-1 agonist semaglutide (Ozempic) to reduce the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes mellitus and CKD. […] Treat these pathologic manifestations of CKD as follows: Anemia When the hemoglobin level is below 10 g/dL, treat with an erythropoiesis-stimulating agent, Hyperphosphatemia Treat with dietary phosphate binders, dietary phosphate restriction, and sodium/hydrogen exchanger 3 (NHE3) inhibitors, Hypocalcemia Treat with calcium supplements with or without calcitriol, Hyperparathyroidism Treat with calcitriol, vitamin D analogues, or calcimimetics, Volume overload Treat with loop diuretics or ultrafiltration, Metabolic acidosis Treat with oral alkali supplementation, Uremic manifestations Treat with long-term renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplantation).

• #68 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  Volume derangements Hypervolemia is common in ESRD, depending on patients’ residual renal function, diet, and use of diuretics. The management of volume overload which goes hand in hand with monitoring for renal function and metabolic abnormalities, is contingent on the patient’s estimated prognosis. The goal of preserving fluid balance is to manage symptoms such as dyspnea, cramping and debility while minimizing electrolyte derangements. For patients expected to have a more protracted survival, aggressive diuresis with sequential nephron blockade using thiazide diuretics (like metolazone) and aldosterone antagonists (like spironolactone) can be offered (17) while obtaining occasional lab draws. For patients with a shorter life expectancy who do not wish to pursue additional workup, maintenance with a loop diuretic as a single agent is appropriate. In general, oral loop diuretics can be continued in CM if this has been maintaining urine output. Subcutaneous (SQ) or intravenous (IV) furosemide can be used for urgent situations as its onset of action is within 30 minutes. If converting to a parenteral route, divide the oral dose by half; IV and SQ are dosed equally. Keep in mind that patients with advanced CKD often need very high doses to achieve diuresis and in ESRD doses of 80-160 mg IV furosemide at a time are often needed (18). See Fast Fact #353.

• #69 Chronic Kidney Disease (CKD) Treatment & Management: Approach Considerations, Delaying or Halting Progression of Chronic Kidney Disease, Treating Pathologic Manifestations of Chronic Kidney Disease

  https://emedicine.medscape.com/article/238798-treatment

  In January 2025 the FDA approved the GLP-1 agonist semaglutide (Ozempic) to reduce the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes mellitus and CKD. […] Treat these pathologic manifestations of CKD as follows: Anemia When the hemoglobin level is below 10 g/dL, treat with an erythropoiesis-stimulating agent, Hyperphosphatemia Treat with dietary phosphate binders, dietary phosphate restriction, and sodium/hydrogen exchanger 3 (NHE3) inhibitors, Hypocalcemia Treat with calcium supplements with or without calcitriol, Hyperparathyroidism Treat with calcitriol, vitamin D analogues, or calcimimetics, Volume overload Treat with loop diuretics or ultrafiltration, Metabolic acidosis Treat with oral alkali supplementation, Uremic manifestations Treat with long-term renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplantation).

• #70 End-Stage Renal Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21081

  Other targets in preventive care and monitoring should include tight glycemic control, cardiovascular risk reduction, and general lifestyle recommendations such as smoking cessation and dietary restriction. Glycemic control is critical. A hemoglobin A1C of less than 7% is generally recommended to prevent or delay microvascular complications in this population. Management with sodium-glucose transporter 2 (SGLT-2) inhibitors may reduce the disease burden in those with type 2 diabetes mellitus. […] Treatment of chronic metabolic acidosis with supplemental renal bicarbonate also may slow the progression of end-stage renal disease. […] For uremic manifestations, long-term renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplantation) is needed. […] Anemia is treated with an erythropoiesis-stimulating agent (ESA) such as erythropoietin.

• #71 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  End-stage renal disease (ESRD) is diagnosed when kidney function is no longer adequate for long-term survival without kidney transplantation or dialysis. […] Kidney transplantation typically yields the best patient outcomes, although most patients are treated with dialysis. […] A palliative approach to ESRD is a reasonable alternative to dialysis, particularly for individuals with limited life expectancy, with severe comorbid conditions, or who wish to avoid medical interventions. […] Insulin is the preferred treatment for patients with ESRD and diabetes mellitus requiring medication. […] Most patients elect to receive dialysis to treat their ESRD, and these patients tend to live longer than those choosing conservative management. […] Patients with ESRD can elect a palliative approach to managing their disease that does not involve dialysis. This approach emphasizes quality of life over the prolongation of life.

• #72 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  Chronic kidney disease is considered a risk factor for severe COVID-19, and vaccination is advised. […] Given the limited life expectancy for most patients with ESRD who do not undergo kidney transplantation, routine cancer screening is discouraged in these patients. […] Most patients receiving dialysis have hypertension. […] Blood pressure control is closely associated with volume status, modifying dialysis sessions to maintain normovolemia can improve blood pressure control. […] Insulin is preferred for most patients who require medication, although glipizide (Glucotrol) and repaglinide are acceptable oral alternatives. […] Patients with ESRD are at increased risk of bleeding due to platelet dysfunction, although dialysis may attenuate this risk. […] Chronic metabolic acidosis is typically resolved with dialysis, but because the condition is associated with increased mortality and other adverse outcomes, those with persistently low bicarbonate concentrations may require oral bicarbonate supplementation.

• #73 Chronic Kidney Disease (CKD) Treatment & Management: Approach Considerations, Delaying or Halting Progression of Chronic Kidney Disease, Treating Pathologic Manifestations of Chronic Kidney Disease

  https://emedicine.medscape.com/article/238798-treatment

  In January 2025 the FDA approved the GLP-1 agonist semaglutide (Ozempic) to reduce the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes mellitus and CKD. […] Treat these pathologic manifestations of CKD as follows: Anemia When the hemoglobin level is below 10 g/dL, treat with an erythropoiesis-stimulating agent, Hyperphosphatemia Treat with dietary phosphate binders, dietary phosphate restriction, and sodium/hydrogen exchanger 3 (NHE3) inhibitors, Hypocalcemia Treat with calcium supplements with or without calcitriol, Hyperparathyroidism Treat with calcitriol, vitamin D analogues, or calcimimetics, Volume overload Treat with loop diuretics or ultrafiltration, Metabolic acidosis Treat with oral alkali supplementation, Uremic manifestations Treat with long-term renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplantation).

• #74 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  Itchiness Chronic kidney disease (CKD)-associated pruritus is a common and distressing symptom (5, 6) (See Fast Fact # 37). Except for gabapentin, which has been studied in variable doses from 100 mg daily to 400 mg twice weekly in a few trials (7), well-controlled evidence for other effective treatments is lacking. Immunomodulating treatments such as topical tacrolimus (8), ultraviolet light B phototherapy (9), and opioid receptor antagonists have documented efficacy (10). New kappa-opioid receptor antagonists that do not cross the blood brain barrier are being studied with promising clinical results (11). […] Dyspnea See Fast Fact #27. Optimize volume status and anemia and address any underlying anxiety. […] Pain Systemic NSAIDs are not recommended but topical NSAIDs have been shown to be effective in musculoskeletal syndromes. Opioids that are safer in renal insufficiency include (12): fentanyl, methadone, and buprenorphine. Hydromorphone is commonly used, but the neuroexcitatory effect of its metabolite is often overlooked. For patients with calciphylaxis (see Fast Fact #325), ketamine (13) and topical morphine (14) have been investigated. For the latter, a morphine 0.125% gel mixture (morphine sulfate 10 mg in 8 g of sterile gel) has been recommended up to three times daily (15); however, the systemic bioavailability of topical morphine seems to be low (16). See Fast Facts #161 and 325.

• #75 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  Itchiness Chronic kidney disease (CKD)-associated pruritus is a common and distressing symptom (5, 6) (See Fast Fact # 37). Except for gabapentin, which has been studied in variable doses from 100 mg daily to 400 mg twice weekly in a few trials (7), well-controlled evidence for other effective treatments is lacking. Immunomodulating treatments such as topical tacrolimus (8), ultraviolet light B phototherapy (9), and opioid receptor antagonists have documented efficacy (10). New kappa-opioid receptor antagonists that do not cross the blood brain barrier are being studied with promising clinical results (11). […] Dyspnea See Fast Fact #27. Optimize volume status and anemia and address any underlying anxiety. […] Pain Systemic NSAIDs are not recommended but topical NSAIDs have been shown to be effective in musculoskeletal syndromes. Opioids that are safer in renal insufficiency include (12): fentanyl, methadone, and buprenorphine. Hydromorphone is commonly used, but the neuroexcitatory effect of its metabolite is often overlooked. For patients with calciphylaxis (see Fast Fact #325), ketamine (13) and topical morphine (14) have been investigated. For the latter, a morphine 0.125% gel mixture (morphine sulfate 10 mg in 8 g of sterile gel) has been recommended up to three times daily (15); however, the systemic bioavailability of topical morphine seems to be low (16). See Fast Facts #161 and 325.

• #76 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  Itchiness Chronic kidney disease (CKD)-associated pruritus is a common and distressing symptom (5, 6) (See Fast Fact # 37). Except for gabapentin, which has been studied in variable doses from 100 mg daily to 400 mg twice weekly in a few trials (7), well-controlled evidence for other effective treatments is lacking. Immunomodulating treatments such as topical tacrolimus (8), ultraviolet light B phototherapy (9), and opioid receptor antagonists have documented efficacy (10). New kappa-opioid receptor antagonists that do not cross the blood brain barrier are being studied with promising clinical results (11). […] Dyspnea See Fast Fact #27. Optimize volume status and anemia and address any underlying anxiety. […] Pain Systemic NSAIDs are not recommended but topical NSAIDs have been shown to be effective in musculoskeletal syndromes. Opioids that are safer in renal insufficiency include (12): fentanyl, methadone, and buprenorphine. Hydromorphone is commonly used, but the neuroexcitatory effect of its metabolite is often overlooked. For patients with calciphylaxis (see Fast Fact #325), ketamine (13) and topical morphine (14) have been investigated. For the latter, a morphine 0.125% gel mixture (morphine sulfate 10 mg in 8 g of sterile gel) has been recommended up to three times daily (15); however, the systemic bioavailability of topical morphine seems to be low (16). See Fast Facts #161 and 325.

• #77 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  Itchiness Chronic kidney disease (CKD)-associated pruritus is a common and distressing symptom (5, 6) (See Fast Fact # 37). Except for gabapentin, which has been studied in variable doses from 100 mg daily to 400 mg twice weekly in a few trials (7), well-controlled evidence for other effective treatments is lacking. Immunomodulating treatments such as topical tacrolimus (8), ultraviolet light B phototherapy (9), and opioid receptor antagonists have documented efficacy (10). New kappa-opioid receptor antagonists that do not cross the blood brain barrier are being studied with promising clinical results (11). […] Dyspnea See Fast Fact #27. Optimize volume status and anemia and address any underlying anxiety. […] Pain Systemic NSAIDs are not recommended but topical NSAIDs have been shown to be effective in musculoskeletal syndromes. Opioids that are safer in renal insufficiency include (12): fentanyl, methadone, and buprenorphine. Hydromorphone is commonly used, but the neuroexcitatory effect of its metabolite is often overlooked. For patients with calciphylaxis (see Fast Fact #325), ketamine (13) and topical morphine (14) have been investigated. For the latter, a morphine 0.125% gel mixture (morphine sulfate 10 mg in 8 g of sterile gel) has been recommended up to three times daily (15); however, the systemic bioavailability of topical morphine seems to be low (16). See Fast Facts #161 and 325.

• #78 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  Itchiness Chronic kidney disease (CKD)-associated pruritus is a common and distressing symptom (5, 6) (See Fast Fact # 37). Except for gabapentin, which has been studied in variable doses from 100 mg daily to 400 mg twice weekly in a few trials (7), well-controlled evidence for other effective treatments is lacking. Immunomodulating treatments such as topical tacrolimus (8), ultraviolet light B phototherapy (9), and opioid receptor antagonists have documented efficacy (10). New kappa-opioid receptor antagonists that do not cross the blood brain barrier are being studied with promising clinical results (11). […] Dyspnea See Fast Fact #27. Optimize volume status and anemia and address any underlying anxiety. […] Pain Systemic NSAIDs are not recommended but topical NSAIDs have been shown to be effective in musculoskeletal syndromes. Opioids that are safer in renal insufficiency include (12): fentanyl, methadone, and buprenorphine. Hydromorphone is commonly used, but the neuroexcitatory effect of its metabolite is often overlooked. For patients with calciphylaxis (see Fast Fact #325), ketamine (13) and topical morphine (14) have been investigated. For the latter, a morphine 0.125% gel mixture (morphine sulfate 10 mg in 8 g of sterile gel) has been recommended up to three times daily (15); however, the systemic bioavailability of topical morphine seems to be low (16). See Fast Facts #161 and 325.

• #79 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  Itchiness Chronic kidney disease (CKD)-associated pruritus is a common and distressing symptom (5, 6) (See Fast Fact # 37). Except for gabapentin, which has been studied in variable doses from 100 mg daily to 400 mg twice weekly in a few trials (7), well-controlled evidence for other effective treatments is lacking. Immunomodulating treatments such as topical tacrolimus (8), ultraviolet light B phototherapy (9), and opioid receptor antagonists have documented efficacy (10). New kappa-opioid receptor antagonists that do not cross the blood brain barrier are being studied with promising clinical results (11). […] Dyspnea See Fast Fact #27. Optimize volume status and anemia and address any underlying anxiety. […] Pain Systemic NSAIDs are not recommended but topical NSAIDs have been shown to be effective in musculoskeletal syndromes. Opioids that are safer in renal insufficiency include (12): fentanyl, methadone, and buprenorphine. Hydromorphone is commonly used, but the neuroexcitatory effect of its metabolite is often overlooked. For patients with calciphylaxis (see Fast Fact #325), ketamine (13) and topical morphine (14) have been investigated. For the latter, a morphine 0.125% gel mixture (morphine sulfate 10 mg in 8 g of sterile gel) has been recommended up to three times daily (15); however, the systemic bioavailability of topical morphine seems to be low (16). See Fast Facts #161 and 325.

• #80 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  Itchiness Chronic kidney disease (CKD)-associated pruritus is a common and distressing symptom (5, 6) (See Fast Fact # 37). Except for gabapentin, which has been studied in variable doses from 100 mg daily to 400 mg twice weekly in a few trials (7), well-controlled evidence for other effective treatments is lacking. Immunomodulating treatments such as topical tacrolimus (8), ultraviolet light B phototherapy (9), and opioid receptor antagonists have documented efficacy (10). New kappa-opioid receptor antagonists that do not cross the blood brain barrier are being studied with promising clinical results (11). […] Dyspnea See Fast Fact #27. Optimize volume status and anemia and address any underlying anxiety. […] Pain Systemic NSAIDs are not recommended but topical NSAIDs have been shown to be effective in musculoskeletal syndromes. Opioids that are safer in renal insufficiency include (12): fentanyl, methadone, and buprenorphine. Hydromorphone is commonly used, but the neuroexcitatory effect of its metabolite is often overlooked. For patients with calciphylaxis (see Fast Fact #325), ketamine (13) and topical morphine (14) have been investigated. For the latter, a morphine 0.125% gel mixture (morphine sulfate 10 mg in 8 g of sterile gel) has been recommended up to three times daily (15); however, the systemic bioavailability of topical morphine seems to be low (16). See Fast Facts #161 and 325.

• #81 End-Stage Renal Disease: Symptom Management and Advance Care Planning | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p705.html

  The prevalence of end-stage renal disease continues to increase, and dialysis is offered to older and more medically complex patients. […] Fentanyl and methadone are considered the safest opioids for use in patients with end-stage renal disease. […] Nondialytic management may be preferable to dialysis initiation in older patients and in those with additional life-limiting illnesses, and may not significantly decrease life expectancy. […] Patients with end-stage renal disease should have advance directives, including documentation of situations in which they would no longer want dialysis. […] Conservative (nondialytic) management of end-stage renal disease can be offered to older adults and patients with multiple comorbidities. […] Delayed initiation of dialysis (when glomerular filtration rate is 5.0 to 7.0 mL per minute per 1.73 m2) yields equivalent outcomes to early initiation.

• #82 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  Although rare, calciphylaxis is a life-threatening condition that may occur in patients with ESRD. […] Chronic kidney disease is considered a coronary heart disease risk equivalent, and patients with ESRD are at high risk of cardiovascular complications and death. […] Pericarditis is not uncommon in patients with ESRD and can manifest differently in this population.

• #83 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  Chronic kidney disease is considered a risk factor for severe COVID-19, and vaccination is advised. […] Given the limited life expectancy for most patients with ESRD who do not undergo kidney transplantation, routine cancer screening is discouraged in these patients. […] Most patients receiving dialysis have hypertension. […] Blood pressure control is closely associated with volume status, modifying dialysis sessions to maintain normovolemia can improve blood pressure control. […] Insulin is preferred for most patients who require medication, although glipizide (Glucotrol) and repaglinide are acceptable oral alternatives. […] Patients with ESRD are at increased risk of bleeding due to platelet dysfunction, although dialysis may attenuate this risk. […] Chronic metabolic acidosis is typically resolved with dialysis, but because the condition is associated with increased mortality and other adverse outcomes, those with persistently low bicarbonate concentrations may require oral bicarbonate supplementation.

• #84 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  Chronic kidney disease is considered a risk factor for severe COVID-19, and vaccination is advised. […] Given the limited life expectancy for most patients with ESRD who do not undergo kidney transplantation, routine cancer screening is discouraged in these patients. […] Most patients receiving dialysis have hypertension. […] Blood pressure control is closely associated with volume status, modifying dialysis sessions to maintain normovolemia can improve blood pressure control. […] Insulin is preferred for most patients who require medication, although glipizide (Glucotrol) and repaglinide are acceptable oral alternatives. […] Patients with ESRD are at increased risk of bleeding due to platelet dysfunction, although dialysis may attenuate this risk. […] Chronic metabolic acidosis is typically resolved with dialysis, but because the condition is associated with increased mortality and other adverse outcomes, those with persistently low bicarbonate concentrations may require oral bicarbonate supplementation.

• #85 Chronic Kidney Disease (CKD) Treatment & Management: Approach Considerations, Delaying or Halting Progression of Chronic Kidney Disease, Treating Pathologic Manifestations of Chronic Kidney Disease

  https://emedicine.medscape.com/article/238798-treatment

  In the FIDELIO-DKD trial of finerenone (Kerendia), a first-in-class selective, nonsteroidal mineralocorticoid receptor antagonist, significant reductions in adverse renal and cardiovascular outcomes were seen in patients with type 2 diabetes and CKD. […] Aggressive blood pressure control can help to delay the decline in kidney function in patients with CKD. […] Use ACEIs or ARBs as tolerated, with close monitoring for renal deterioration and for hyperkalemia. […] Data support the use of ACEIs or ARBs in diabetic kidney disease with or without proteinuria. […] In a study of 113 patients with CKD stages 2-4 and subclinical hypothyroidism, thyroid hormone replacement therapy (THRT) with L-thyroxine delayed the rate of decline in kidney function to ESKD. […] A study by Shurraw et al showed that in people with nonhemodialysis-dependent CKD, a hemoglobin A1c (HbA1c) level higher than 9% is associated with worse clinical outcomes.

• #86 Chronic Kidney Disease (CKD) Treatment & Management: Approach Considerations, Delaying or Halting Progression of Chronic Kidney Disease, Treating Pathologic Manifestations of Chronic Kidney Disease

  https://emedicine.medscape.com/article/238798-treatment

  In the FIDELIO-DKD trial of finerenone (Kerendia), a first-in-class selective, nonsteroidal mineralocorticoid receptor antagonist, significant reductions in adverse renal and cardiovascular outcomes were seen in patients with type 2 diabetes and CKD. […] Aggressive blood pressure control can help to delay the decline in kidney function in patients with CKD. […] Use ACEIs or ARBs as tolerated, with close monitoring for renal deterioration and for hyperkalemia. […] Data support the use of ACEIs or ARBs in diabetic kidney disease with or without proteinuria. […] In a study of 113 patients with CKD stages 2-4 and subclinical hypothyroidism, thyroid hormone replacement therapy (THRT) with L-thyroxine delayed the rate of decline in kidney function to ESKD. […] A study by Shurraw et al showed that in people with nonhemodialysis-dependent CKD, a hemoglobin A1c (HbA1c) level higher than 9% is associated with worse clinical outcomes.

• #87 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  GI symptoms Renally-dosed haloperidol is a prudent initial step for nausea management, as it may improve other terminal symptoms in patients with ESRD such as agitation (19). Ondansetron and metoclopramide can be considered as well. The diet should be liberalized, despite metabolic concerns. Dysgeusia and anorexia should be assessed regularly. See Fast Facts # 100, 304, and 314 […] Pharmacologic considerations Other interventions that can address electrolyte or acid-base derangements which can potentially cause distressing pain, cramping, or weakness should be discussed with the patient. These include therapies for hyperkalemia, acidemia, and mineral bone disease. Stopping blood pressure medications such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ACE/ARB) is recommended as tight blood pressure control only conveys long-term benefits and elevated blood pressure is rarely symptomatic. ACE/ARBs also pose risks of hyperkalemia and symptomatic hypotension complicated by dizziness and falls.

• #88 Management of End-stage Renal Disease Associated with Systemic Rheumatic Diseases | JMA Journal

  https://www.jmaj.jp/detail.php?id=10.31662%2Fjmaj.2019-0020

  Collaboration between rheumatologists and nephrologists is needed more than ever and is expected to produce a complementary effect and achieve better outcomes in clinical settings, although this cooperation has not always been conducted appropriately. […] The benefit of the renin-angiotensin-aldosterone system (RAAS) blockade for blood pressure control in patients with CKD and hemodialysis is controversial because most trials evaluating the renocardiovascular benefit of RAAS blockade exclude patients with ESRD. […] The benefits of statins in patients with CKD is also controversial. However, statins should be considered in patients who have multiple risk factors for cardiovascular disease, because the incidence of cardiovascular disease in patients with RDs is higher than in the control population.

• #89 Management of End-stage Renal Disease Associated with Systemic Rheumatic Diseases | JMA Journal

  https://www.jmaj.jp/detail.php?id=10.31662%2Fjmaj.2019-0020

  Collaboration between rheumatologists and nephrologists is needed more than ever and is expected to produce a complementary effect and achieve better outcomes in clinical settings, although this cooperation has not always been conducted appropriately. […] The benefit of the renin-angiotensin-aldosterone system (RAAS) blockade for blood pressure control in patients with CKD and hemodialysis is controversial because most trials evaluating the renocardiovascular benefit of RAAS blockade exclude patients with ESRD. […] The benefits of statins in patients with CKD is also controversial. However, statins should be considered in patients who have multiple risk factors for cardiovascular disease, because the incidence of cardiovascular disease in patients with RDs is higher than in the control population.

• #90 Psychological Interventions for End-Stage Renal Disease Patients’ Receiving Hemodialysis | IntechOpen

  https://www.intechopen.com/chapters/88102

  Hemodialysis is the lifesaving treatment for End-Stage Renal Disease (ESRD) patients; however, the treatments nature impacts the patients quality of life and mental health. […] The mental health of ESRD patients receiving hemodialysis can be improved with cognitive-behavioral therapy, psychoeducation, relaxation techniques, peer support groups, spiritual therapy, and technology-based psychological interventions. […] Psychological interventions not only have the potential to reduce depression and anxiety among patients receiving hemodialysis but also improves their quality of life. […] Therefore, it is important to improve the quality of life even in the absence of any mental health problem by fostering healthy thoughts and behaviors, which can be possible by incorporating psychological interventions in health care of HD patients.

• #91 Psychological Interventions for End-Stage Renal Disease Patients’ Receiving Hemodialysis | IntechOpen

  https://www.intechopen.com/chapters/88102

  Hemodialysis is the lifesaving treatment for End-Stage Renal Disease (ESRD) patients; however, the treatments nature impacts the patients quality of life and mental health. […] The mental health of ESRD patients receiving hemodialysis can be improved with cognitive-behavioral therapy, psychoeducation, relaxation techniques, peer support groups, spiritual therapy, and technology-based psychological interventions. […] Psychological interventions not only have the potential to reduce depression and anxiety among patients receiving hemodialysis but also improves their quality of life. […] Therefore, it is important to improve the quality of life even in the absence of any mental health problem by fostering healthy thoughts and behaviors, which can be possible by incorporating psychological interventions in health care of HD patients.

• #92 Psychological Interventions for End-Stage Renal Disease Patients’ Receiving Hemodialysis | IntechOpen

  https://www.intechopen.com/chapters/88102

  Psychological interventions can be effectively improving the mental health of ESRD patients receiving HD. […] Cognitive-behavioral therapy (CBT), psychoeducation/educational interventions, relaxation techniques, peer support groups, spiritual therapy, technology-based psychological interventions, and other psychotherapeutic techniques are effective in improving the mental health of ESRD patients receiving HD. […] CBT is the widely used psychological intervention for HD patients. […] Moreover, CBT helps to internalize HD patients locus of control. […] Therefore, reduce depression and anxiety and improves quality of life of the patients undergoing HD. […] Psychoeducation educates patients about the nature of their illness and how to manage the problems associated with illness. […] Relaxation techniques, including Bensons relaxation technique, progressive muscle relaxation, and music relaxation therapy, can help ESRD patients undergoing HD.

• #93 Psychological Interventions for End-Stage Renal Disease Patients’ Receiving Hemodialysis | IntechOpen

  https://www.intechopen.com/chapters/88102

  Psychological interventions can be effectively improving the mental health of ESRD patients receiving HD. […] Cognitive-behavioral therapy (CBT), psychoeducation/educational interventions, relaxation techniques, peer support groups, spiritual therapy, technology-based psychological interventions, and other psychotherapeutic techniques are effective in improving the mental health of ESRD patients receiving HD. […] CBT is the widely used psychological intervention for HD patients. […] Moreover, CBT helps to internalize HD patients locus of control. […] Therefore, reduce depression and anxiety and improves quality of life of the patients undergoing HD. […] Psychoeducation educates patients about the nature of their illness and how to manage the problems associated with illness. […] Relaxation techniques, including Bensons relaxation technique, progressive muscle relaxation, and music relaxation therapy, can help ESRD patients undergoing HD.

• #94 Psychological Interventions for End-Stage Renal Disease Patients’ Receiving Hemodialysis | IntechOpen

  https://www.intechopen.com/chapters/88102

  Psychological interventions can be effectively improving the mental health of ESRD patients receiving HD. […] Cognitive-behavioral therapy (CBT), psychoeducation/educational interventions, relaxation techniques, peer support groups, spiritual therapy, technology-based psychological interventions, and other psychotherapeutic techniques are effective in improving the mental health of ESRD patients receiving HD. […] CBT is the widely used psychological intervention for HD patients. […] Moreover, CBT helps to internalize HD patients locus of control. […] Therefore, reduce depression and anxiety and improves quality of life of the patients undergoing HD. […] Psychoeducation educates patients about the nature of their illness and how to manage the problems associated with illness. […] Relaxation techniques, including Bensons relaxation technique, progressive muscle relaxation, and music relaxation therapy, can help ESRD patients undergoing HD.

• #95 Psychological Interventions for End-Stage Renal Disease Patients’ Receiving Hemodialysis | IntechOpen

  https://www.intechopen.com/chapters/88102

  Psychological interventions can be effectively improving the mental health of ESRD patients receiving HD. […] Cognitive-behavioral therapy (CBT), psychoeducation/educational interventions, relaxation techniques, peer support groups, spiritual therapy, technology-based psychological interventions, and other psychotherapeutic techniques are effective in improving the mental health of ESRD patients receiving HD. […] CBT is the widely used psychological intervention for HD patients. […] Moreover, CBT helps to internalize HD patients locus of control. […] Therefore, reduce depression and anxiety and improves quality of life of the patients undergoing HD. […] Psychoeducation educates patients about the nature of their illness and how to manage the problems associated with illness. […] Relaxation techniques, including Bensons relaxation technique, progressive muscle relaxation, and music relaxation therapy, can help ESRD patients undergoing HD.

• #96 Psychological Interventions for End-Stage Renal Disease Patients’ Receiving Hemodialysis | IntechOpen

  https://www.intechopen.com/chapters/88102

  Peer-to-peer support improves the quality of life, self-management, hope, and mental health of the HD patients undergoing. […] Spiritual therapy was effectively used with patients receiving HD to improve their well-being, lifestyle, hope, resilience, and reducing their stress, anxiety, depression. […] The use of technology-based psychological interventions is accepted, feasible, and needs minimum additional resources to address the mental health of patients on maintenance HD. […] Psychological intervention in several forms also positively changes the HD experience for ESRD patients. […] These non-pharmacological psychological interventions are extremely important and should be part of the health care for ESRD patients undergoing HD because HD is not merely a treatment procedure for ESRD it actually leads to the major lifestyle change that challenges patients mental health.

• #97 Psychological Interventions for End-Stage Renal Disease Patients’ Receiving Hemodialysis | IntechOpen

  https://www.intechopen.com/chapters/88102

  Peer-to-peer support improves the quality of life, self-management, hope, and mental health of the HD patients undergoing. […] Spiritual therapy was effectively used with patients receiving HD to improve their well-being, lifestyle, hope, resilience, and reducing their stress, anxiety, depression. […] The use of technology-based psychological interventions is accepted, feasible, and needs minimum additional resources to address the mental health of patients on maintenance HD. […] Psychological intervention in several forms also positively changes the HD experience for ESRD patients. […] These non-pharmacological psychological interventions are extremely important and should be part of the health care for ESRD patients undergoing HD because HD is not merely a treatment procedure for ESRD it actually leads to the major lifestyle change that challenges patients mental health.

• #98 Psychological Interventions for End-Stage Renal Disease Patients’ Receiving Hemodialysis | IntechOpen

  https://www.intechopen.com/chapters/88102

  Peer-to-peer support improves the quality of life, self-management, hope, and mental health of the HD patients undergoing. […] Spiritual therapy was effectively used with patients receiving HD to improve their well-being, lifestyle, hope, resilience, and reducing their stress, anxiety, depression. […] The use of technology-based psychological interventions is accepted, feasible, and needs minimum additional resources to address the mental health of patients on maintenance HD. […] Psychological intervention in several forms also positively changes the HD experience for ESRD patients. […] These non-pharmacological psychological interventions are extremely important and should be part of the health care for ESRD patients undergoing HD because HD is not merely a treatment procedure for ESRD it actually leads to the major lifestyle change that challenges patients mental health.

• #99 FF #404 Depression in End-Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/depression-in-end-stage-renal-disease/

  Background: End-stage renal disease (ESRD) occurs when individuals have an estimated glomerular filtration rate (GFR) < 15 ml/min/1.73 m² body surface area or require long-term dialysis irrespective of GFR. Depression is common in patients with ESRD, with estimated prevalence rates between 20% and 40%, yet it is underdiagnosed and undertreated. Patients with ESRD and depression have longer hospital stays, poorer quality of life, and are twice as likely to die or require hospitalization within a year compared to those without depression. This Fast Fact reviews depression management considerations in ESRD. [...] Non-pharmacologic therapy: Psychological interventions such as individual and group cognitive behavioral therapy (CBT) are considered to be efficient interventions for depression in patients with ESRD. Due to reluctance to attend appointments on non-dialysis days, non-pharmacologic interventions which take place on the dialysis unit such as chairside CBT therapy have been investigated in the hopes of improved long-term adherence. Mind-body techniques including guided imagery, breathing, and mindfulness provided in the hemodialysis unit via smart-phone apps have also been examined in early investigations.

• #100 FF #404 Depression in End-Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/depression-in-end-stage-renal-disease/

  Background: End-stage renal disease (ESRD) occurs when individuals have an estimated glomerular filtration rate (GFR) < 15 ml/min/1.73 m² body surface area or require long-term dialysis irrespective of GFR. Depression is common in patients with ESRD, with estimated prevalence rates between 20% and 40%, yet it is underdiagnosed and undertreated. Patients with ESRD and depression have longer hospital stays, poorer quality of life, and are twice as likely to die or require hospitalization within a year compared to those without depression. This Fast Fact reviews depression management considerations in ESRD. [...] Non-pharmacologic therapy: Psychological interventions such as individual and group cognitive behavioral therapy (CBT) are considered to be efficient interventions for depression in patients with ESRD. Due to reluctance to attend appointments on non-dialysis days, non-pharmacologic interventions which take place on the dialysis unit such as chairside CBT therapy have been investigated in the hopes of improved long-term adherence. Mind-body techniques including guided imagery, breathing, and mindfulness provided in the hemodialysis unit via smart-phone apps have also been examined in early investigations.

• #101 FF #404 Depression in End-Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/depression-in-end-stage-renal-disease/

  Summary: Non-pharmacologic interventions are recommended as first-line for patients with ESRD and mild-to-moderate depression, particularly if offered during dialysis. When pharmacotherapy is indicated, selecting an antidepressant with additional benefits is advised. Sertraline may improve pruritis and fatigue. Venlafaxine ER (starting dose 37.5 mg) has the potential benefit of reducing neuropathic pain. Bupropion fewer sexual side effects, weight gain, and RLS.

• #102 FF #404 Depression in End-Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/depression-in-end-stage-renal-disease/

  Summary: Non-pharmacologic interventions are recommended as first-line for patients with ESRD and mild-to-moderate depression, particularly if offered during dialysis. When pharmacotherapy is indicated, selecting an antidepressant with additional benefits is advised. Sertraline may improve pruritis and fatigue. Venlafaxine ER (starting dose 37.5 mg) has the potential benefit of reducing neuropathic pain. Bupropion fewer sexual side effects, weight gain, and RLS.

• #103 End-Stage Renal Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499861/

  More than 500,000 people in the United States live with end-stage renal disease (ESRD). […] This activity explains when this condition should be considered in the differential diagnosis and how to evaluate this condition properly. Furthermore, it highlights the interprofessional team’s role in caring for patients with this condition. […] Summarize the treatment options for end-stage renal disease. […] Treatment of end-stage renal disease involves correcting parameters at the level of the patient’s presentation. Interventions aimed at slowing the rate of kidney disease should be initiated and can include: […] For uremic manifestations, long-term renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplantation) is needed. […] Early patient education should be initiated regarding natural disease progression, different modalities for dialysis, and renal transplantation.

• #104 End-Stage Renal Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499861/

  Every patient with end-stage renal disease should be timely referred for renal transplantation. […] Indications for renal replacement therapy in patients with CKD include the following: Severe metabolic acidosis, Hyperkalemia, Pericarditis, Encephalopathy, Intractable volume overload, Failure to thrive and malnutrition, Peripheral neuropathy, Intractable gastrointestinal symptoms, Glomerular filtration rate (GFR) of 5 to 9 mL/min/1.73 m^2, irrespective of the symptoms or the presence or absence of other comorbidities. […] There is no cure for end-stage renal disease, and all the available treatments are short-term. Thus, the key to improving long-term outcomes is preventing the disease’s progression.

• #105 End-Stage Renal Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21081

  Hyperphosphatemia is treated with phosphate binders (calcium acetate, sevelamer carbonate, or lanthanum carbonate) and dietary phosphate restriction. […] Lifestyle modification and dietary restrictions are routinely recommended. For example, adhering to a low salt diet (less than 2 g/day), a renal diet (avoiding foods that are high in phosphorus), and restricting daily protein to 0.8 g per kg body weight per day is essential to managing disease burden. […] Planning for Long-term Renal Replacement Therapy […] Early patient education should be initiated regarding natural disease progression, different modalities for dialysis, and renal transplantation. For patients in whom transplantation is not imminent, a primary arteriovenous fistula should be created in advance of the anticipated date of dialysis. Every patient with end-stage renal disease should be timely referred for renal transplantation.

• #106 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  GI symptoms Renally-dosed haloperidol is a prudent initial step for nausea management, as it may improve other terminal symptoms in patients with ESRD such as agitation (19). Ondansetron and metoclopramide can be considered as well. The diet should be liberalized, despite metabolic concerns. Dysgeusia and anorexia should be assessed regularly. See Fast Facts # 100, 304, and 314 […] Pharmacologic considerations Other interventions that can address electrolyte or acid-base derangements which can potentially cause distressing pain, cramping, or weakness should be discussed with the patient. These include therapies for hyperkalemia, acidemia, and mineral bone disease. Stopping blood pressure medications such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ACE/ARB) is recommended as tight blood pressure control only conveys long-term benefits and elevated blood pressure is rarely symptomatic. ACE/ARBs also pose risks of hyperkalemia and symptomatic hypotension complicated by dizziness and falls.

• #107 Common Drugs Prescribed for Dialysis Patients – DaVita

  http://www.davita.com/treatment-services/prescription/common-drugs-prescribed-for-dialysis-patients

  Nearly all patients with end stage renal disease (ESRD) who are on dialysis, have anemia. […] Most patients with renal failure on hemodialysis will get erythropoietin during each treatment by intravenous injection into the return dialysis tubing. […] Most dialysis patients need to receive iron. […] The oral form of active vitamin D may be effective in preventing high PTH. […] Preventing or reversing this process can be done through diet and medicines such as phosphorus binders. […] Most nephrologists feel that the use of a B-complex vitamin along with folic acid is a good protection for when patients don’t have an appetite. […] High dose folic acid therapy is being evaluated as a possible preventative treatment in dialysis patients. […] Vitamin E has been said to help many people as a preventative measure for cramps when taken either before dialysis or at bedtime. […] People with CKD, as well as those on dialysis, need to be involved in all areas of their care.

• #108 Common Drugs Prescribed for Dialysis Patients – DaVita

  http://www.davita.com/treatment-services/prescription/common-drugs-prescribed-for-dialysis-patients

  Nearly all patients with end stage renal disease (ESRD) who are on dialysis, have anemia. […] Most patients with renal failure on hemodialysis will get erythropoietin during each treatment by intravenous injection into the return dialysis tubing. […] Most dialysis patients need to receive iron. […] The oral form of active vitamin D may be effective in preventing high PTH. […] Preventing or reversing this process can be done through diet and medicines such as phosphorus binders. […] Most nephrologists feel that the use of a B-complex vitamin along with folic acid is a good protection for when patients don’t have an appetite. […] High dose folic acid therapy is being evaluated as a possible preventative treatment in dialysis patients. […] Vitamin E has been said to help many people as a preventative measure for cramps when taken either before dialysis or at bedtime. […] People with CKD, as well as those on dialysis, need to be involved in all areas of their care.

• #109 Common Drugs Prescribed for Dialysis Patients – DaVita

  http://www.davita.com/treatment-services/prescription/common-drugs-prescribed-for-dialysis-patients

  Nearly all patients with end stage renal disease (ESRD) who are on dialysis, have anemia. […] Most patients with renal failure on hemodialysis will get erythropoietin during each treatment by intravenous injection into the return dialysis tubing. […] Most dialysis patients need to receive iron. […] The oral form of active vitamin D may be effective in preventing high PTH. […] Preventing or reversing this process can be done through diet and medicines such as phosphorus binders. […] Most nephrologists feel that the use of a B-complex vitamin along with folic acid is a good protection for when patients don’t have an appetite. […] High dose folic acid therapy is being evaluated as a possible preventative treatment in dialysis patients. […] Vitamin E has been said to help many people as a preventative measure for cramps when taken either before dialysis or at bedtime. […] People with CKD, as well as those on dialysis, need to be involved in all areas of their care.

• #110 End-stage kidney disease: The last 12 months

  https://www1.racgp.org.au/ajgp/2021/april/end-stage-kidney-disease-the-last-12-months-1

  The care of patients with ESKD, up to and including the final year of their lives, requires a careful and respectful coordination of the relevant specialist services and general practice. […] For patients on dialysis, the locus of care is often the dialysis centre and the nephrology team. For all patients with ESKD, nephrology, RSC and general practice have an important role.

• #111 End-Stage Renal Disease (ESRD): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/end-stage-renal-disease-nursing-diagnosis-care-plan/

  End-stage renal disease (ESRD), also called end-stage kidney disease or kidney failure, is the final and permanent stage of chronic kidney disease. In this stage, kidneys can no longer function on their own and the patient must receive dialysis or kidney transplantation to survive. […] End-stage renal disease is irreversible and has no cure. Nursing care priorities for patients with end-stage renal disease include: Prevent and treat complications, Assist in kidney transplantation or dialysis, Instruct on the management of chronic conditions, Implement fluid restrictions and diet recommendations, Promote physical and psychosocial well-being, Enhance the patients overall quality of life, Instruct on lifestyle modifications, Provide support to the patient and family, Collaborate with the nephrologist and other team members.

• #112 Management of End-stage Renal Disease Associated with Systemic Rheumatic Diseases | JMA Journal

  https://www.jmaj.jp/detail.php?id=10.31662%2Fjmaj.2019-0020

  It is important to note that most immunosuppressive agents, except for azathioprine and CYC, show no intradialytic clearance with hemodialysis. […] Hydroxychloroquine has been used as the standard drug for patients with SLE because of its favorable safety profile and efficacy. […] MMF has emerged as an alternative agent for both induction and maintenance therapy in LN. […] CYC has been used for many years for various RDs. […] A team approach involving rheumatologists and nephrologists is expected to produce a complementary effect and achieve better outcomes. […] Collaboration between rheumatologists and nephrologists is more important than ever to improve quality of life in patients with renal impairment due to RDs.

• #113 Kidney failure (ESRD) – Symptoms, stages, & treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/kidney-failure

  Kidney failure means your kidneys are no longer able to work well enough to keep you alive. With kidney failure, 85-90% of your kidney function is gone. People with kidney failure will need dialysis or a kidney transplant to survive. […] There is no cure for kidney failure, but with treatment it is possible to live a longer and productive life. […] Dialysis and kidney transplant are the two treatments for people with kidney failure. Dialysis treatments or a transplanted kidney will take over some of the work from your damaged kidneys and remove wastes and extra fluid from your body. This will make many of your symptoms better. You also have the option to choose not to pursue either option, also known as conservative management. […] Dialysis: There are two types of dialysis- hemodialysis and peritoneal dialysis. Both remove waste products and extra fluid from your blood. Hemodialysis uses an artificial kidney machine, while peritoneal dialysis uses the lining in the belly. Hemodialysis treatments can be done at your home or in a clinic. Peritoneal dialysis is usually done at your home.

• #114 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  End-stage renal disease (ESRD) is diagnosed when kidney function is no longer adequate for long-term survival without kidney transplantation or dialysis. […] Kidney transplantation typically yields the best patient outcomes, although most patients are treated with dialysis. […] A palliative approach to ESRD is a reasonable alternative to dialysis, particularly for individuals with limited life expectancy, with severe comorbid conditions, or who wish to avoid medical interventions. […] Insulin is the preferred treatment for patients with ESRD and diabetes mellitus requiring medication. […] Most patients elect to receive dialysis to treat their ESRD, and these patients tend to live longer than those choosing conservative management. […] Patients with ESRD can elect a palliative approach to managing their disease that does not involve dialysis. This approach emphasizes quality of life over the prolongation of life.

• #115 Kidney failure (ESRD) – Symptoms, stages, & treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/kidney-failure

  Kidney failure means your kidneys are no longer able to work well enough to keep you alive. With kidney failure, 85-90% of your kidney function is gone. People with kidney failure will need dialysis or a kidney transplant to survive. […] There is no cure for kidney failure, but with treatment it is possible to live a longer and productive life. […] Dialysis and kidney transplant are the two treatments for people with kidney failure. Dialysis treatments or a transplanted kidney will take over some of the work from your damaged kidneys and remove wastes and extra fluid from your body. This will make many of your symptoms better. You also have the option to choose not to pursue either option, also known as conservative management. […] Dialysis: There are two types of dialysis- hemodialysis and peritoneal dialysis. Both remove waste products and extra fluid from your blood. Hemodialysis uses an artificial kidney machine, while peritoneal dialysis uses the lining in the belly. Hemodialysis treatments can be done at your home or in a clinic. Peritoneal dialysis is usually done at your home.

• #116 Kidney Failure Treatment Without Dialysis: Your Options

  https://www.healthline.com/health/kidney-disease/kidney-failure-treatment-without-dialysis

  A kidney transplant can help treat kidney failure. During this procedure, a surgical team implants a healthy kidney from a donor into your body. This can help boost your kidney function. […] Dialysis and kidney transplant are still the two main treatments for kidney failure. […] Additionally, the Food and Drug Administration (FDA) has recently approved drugs to prevent the progression of kidney disease and, therefore, prevent kidney failure. […] A kidney transplant is another treatment option for people with kidney failure who choose not to have long-term dialysis. […] Kidney failure may also be called end stage renal disease.

• #117 Kidney Failure Treatment Without Dialysis: Your Options

  https://www.healthline.com/health/kidney-disease/kidney-failure-treatment-without-dialysis

  A kidney transplant can help treat kidney failure. During this procedure, a surgical team implants a healthy kidney from a donor into your body. This can help boost your kidney function. […] Dialysis and kidney transplant are still the two main treatments for kidney failure. […] Additionally, the Food and Drug Administration (FDA) has recently approved drugs to prevent the progression of kidney disease and, therefore, prevent kidney failure. […] A kidney transplant is another treatment option for people with kidney failure who choose not to have long-term dialysis. […] Kidney failure may also be called end stage renal disease.

• #118 Dialysis and Beyond Navigating Treatment Options for End-Stage Renal Disease – Associates in Nephrology, PC

  https://www.associatesinnephrologypc.com/2023/10/06/dialysis-and-beyond-navigating-treatment-options-for-end-stage-renal-disease/

  People who choose not to have dialysis or kidney transplants can have palliative or supportive care to manage their symptoms and feel better. Palliative care can also be combined with dialysis or kidney transplants. Without dialysis or kidney transplant, kidney failure progresses and leads to death. […] Navigating your treatment options for end-stage renal disease can be overwhelming. Therefore, it is important to consult a kidney specialist for a comprehensive medical evaluation to choose the right treatment options for you. […] The patient’s health status is a critical factor that influences the choice of treatment for end-stage renal disease. […] Long-term outlook refers to the expected course and outcome of the medical condition over an extended period. […] Compared to long-term dialysis, kidney transplants offer the potential for longer and better quality of life.

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