General Internal Medicine

End stage kidney disease

Questions discussed in this category

What is the maximum diuretic regimen recommended in patients with end-stage kidney disease who have residual renal function and volume overload?

4 Answers available

Do you make any dose adjustments for patients with ESKD who are on apixaban and do not otherwise meet criteria for reduced dosing?

2 Answers available

What treatment options would you consider for a young patient with limited mobility, low bone mass and multiple vertebral compression fractures who is on dialysis for advanced kidney disease?

1 Answer available

For which patients with calciphylaxis would you recommend a parathyroidectomy?

4 Answers available

How would you manage an ESKD patient who complains of severe fatigue after hemodialysis, but does not experience intradialytic or post-dialysis hypotension and has not responded to dry weight adjustments?

2 Answers available

What is your approach to management of intradialytic hypotension and autonomic dysfunction in a patient with ESKD?

3 Answers available

Should CT coronary calcium score be avoided in dialysis patients in light of presumed high prevalence of CAC in this population?

3 Answers available

Do you stop ACEi or ARB medications in patients with ESKD who are on hemodialysis and have issues with chronic hyperkalemia?

2 Answers available

Do you take any different approaches for patients with end stage kidney disease who are about to be initiated on intermittent hemodialysis and have residual renal function?

1 Answer available

Would you recommend transition to hemodialysis for a patient with calciphylaxis, hyperphosphatemia, and ESKD on peritoneal dialysis?

2 Answers available

Do you find adding fludrocortisone helpful in treating persistent hypotension in HD patients already on midodrine and without evidence of adrenal insufficiency?

5 Answers available

How do you counsel patients on peritoneal dialysis regarding the safety of engaging in aerobic and resistance exercises, considering the risk of developing abdominal wall complications?

1 Answer available

How do you approach palliative conversations about what patients can expect when deciding to stop maintenance dialysis?

1 Answer available

Are there instances when you dose sodium zirconium cyclosilicate more than once daily for long term therapy for patients with end stage kidney disease and hyperkalemia?

1 Answer available

Do you generally prefer to continue hydroxychloroquine in lupus patients who develop ESRD despite the low likelihood of clinically active disease in this patient population?

4 Answers available

Do you avoid sodium zirconium cyclosilicate use in your patients with ESKD and hyperkalemia who also have peripheral edema?

1 Answer available

How would you approach a patient with end stage kidney disease on peritoneal dialysis who has an adequate Kt/V but persistent azotemia?

1 Answer available

Do you recommend daily topical exit site antibiotic use for patients with a peritoneal dialysis catheter that is only currently being accessed for once weekly flushes?

2 Answers available

Given the risk of hypocalcemia in dialysis dependent patients treated with denosumab, what is the best method of treatment for osteoporosis for these patients, and should we be transitioning to a different agent?

2 Answers available

How do you time 24 hour urine collections when calculating creatinine clearance for patients receiving thrice weekly hemodialysis?

2 Answers available

Should GLP1 R agonists be used as first line glucose lowering agents in patients with ESKD and DM2?

1 Answer available

Are there instances when you recommend femoral vein dialysis catheter placement in patients newly started on hemodialysis in an effort to preserve upper extremity future fistula options?

1 Answer available

What is your approach to managing intradialytic cramping that recurs despite multiple dry weight adjustments in a patient with ESKD?

2 Answers available

How long after surgical repair of a pleuroperitoneal leak do you resume peritoneal dialysis?

1 Answer available

How do you manage patients with end stage kidney disease and recurrent ascites who do not have any evidence of cardiac or liver disease?

3 Answers available

How often do you check carnitine levels in your patients with end stage kidney disease on hemodialysis?

2 Answers available

What is your approach to managing osteoporosis in patients with end stage kidney disease?

1 Answer available

Do you avoid ESAs in patients with end stage kidney disease who also have heart failure due to increased risk of stroke?

2 Answers available

What are your management strategies for patients with end stage kidney disease on hemodialysis who develop hypercalcemia of immobility?

1 Answer available

Do you recommend placement of a backup AV fistula in an advanced CKD patient who is planning to do peritoneal dialysis?

Prior retrospective studies have suggested a lower rate of future catheter use with a backup AVF in place (Haralabopoulos et al., PMID 32852703).

4 Answers available

How do you distinguish between primary and tertiary hyperparathyroidism in a patient with ESRD?

1 Answer available

What are the important aspects that you mention when consenting patients for hemodialysis?

1 Answer available

How do you manage severe intra-dialytic hypertension that is not responsive to dry weight challenge in an asymptomatic patient with ESKD?

1 Answer available

What is your approach to establishing a dry weight in a pregnant patient with ESKD on hemodialysis given the expectation of weight increase and pregnancy-related edema?

2 Answers available

What is your approach to determining the need for continued isolation in the dialysis unit for an ESKD patient who had a positive hepatitis B surface antigen one year ago but who now has a negative HbsAg in the absence of treatment?

1 Answer available

Do you recommend continuing SGLT2 inhibitors in patients with diabetic kidney disease and congestive heart failure who have been taking the medication for several years and later develop end stage kidney disease?

3 Answers available

When do you avoid or stop erythropoietin-stimulating agents in patients with anemia and end stage kidney disease?

1 Answer available

When do you avoid or stop iron agents in patients with anemia and end stage kidney disease?

1 Answer available

Do you recommend continuing peritoneal dialysis in an ESKD patient on peritoneal dialysis who is diagnosed with encapsulating peritoneal sclerosis since abdominal symptoms may worsen when peritoneal dialysis is stopped?

1 Answer available

How do you manage recurrent hemodialysis filter clotting in an in-center ESKD patient with heparin-induced thrombocytopenia?

1 Answer available

Do you recommend targeting a higher Kt/V in an ESKD patient on hemodialysis with pruritis and a Kt/V of 1.4?

1 Answer available

How soon after an end stage kidney disease patient receives a MRI study with gadolinium contrast do you perform their next hemodialysis session?

1 Answer available

What is your PTH threshold for referring an ESKD patient with secondary hyperparathyroidism on maximum medical therapy for parathyroidectomy?

1 Answer available

What is the preferred timing for removal of a peritoneal dialysis catheter in a patient who has transitioned to hemodialysis?

1 Answer available

What is the antifungal prophylaxis regimen that you use in patients on peritoneal dialysis who are receiving antibiotics?

1 Answer available

Papers discussed in this category

Perit Dial Int, 2022 Mar

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment.

Radiology, 2021 Jan

Use of Intravenous Gadolinium-based Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation.

Renal failure, 2006

Intraperitoneal sodium thiosulfate for the treatment of calciphylaxis.

Perit Dial Int, 2017 Jul-Aug

Length of Time on Peritoneal Dialysis and Encapsulating Peritoneal Sclerosis - Position Paper for ISPD: 2017 Update.

Semin Nephrol, 2017 Jan

Encapsulating Peritoneal Sclerosis.

The New England journal of medicine, 2015 Sep 17

Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.

The New England journal of medicine, 2020 Sep 24

Dapagliflozin in Patients with Chronic Kidney Disease.

Kidney research and clinical practice, 2018 Mar 31

Use of fludrocortisone for intradialytic hypotension.

Kidney international, 2001 Mar

Role of diuretics in the preservation of residual renal function in patients on continuous ambulatory peritoneal dialysis.

American journal of nephrology, 1992

Acute and long-term effects of therapy with high-dose furosemide in chronic hemodialysis patients.

Kidney research and clinical practice, 2019 Mar 31

Efficacy of triple diuretic treatment in continuous ambulatory peritoneal dialysis patients: A randomized controlled trial.

The New England journal of medicine, 2009-11-19

A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease.

The New England journal of medicine, 2006 Nov 16

Correction of anemia with epoetin alfa in chronic kidney disease.

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 2023 May 26

ISPD Catheter-related Infection Recommendations: 2023 Update.

Perit Dial Int, 2020 Jan 21

International Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goal-directed peritoneal dialysis.

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 2020 Jan 17

Accuracy of the estimation of and the implications this has when applying / for measuring dialysis dose in peritoneal dialysis.

Nephron, 1986

Intraabdominal pressures during natural activities in patients treated with continuous ambulatory peritoneal dialysis.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2007 Jan 25

No impact of hyperkalaemia with renin-angiotensin system blockades in maintenance haemodialysis patients.

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