Pre-dialysis management of CRF


The aim is to:

  • Prevent progression of CRF so far as possible
  • Prevent complications of CRF
  • Ensure timely and appropriate planning of RRT when necessary (see
    Preparing patients for RRT)
Fluid balance Prevent hypervolaemia (Na restriction, diuretics)
Avoid hypovolaemia (no oedema, postural hypotension)
Watch out for sodium-losing patients who will benefit from Na supplementation.
Hypertension See
blood pressure in renal disease
Diet See
diet
Hyperlipidaemia See
hyperlipidaemia
Acidosis Prescribe NaHCO3 to keep plasma bicarbonate ≥20 if Na load perm
Osteodystrophy Prescribe alfacalcidol (calcitriol equally effective) when there is hypocalcaemia or when PTH >2x normal in the presence of normal serum calcium.
PO4 should be kept at ≤1.8 mmol/l by dietary restriction and the use of phosphate binders.
See
osteodystrophy

 

 

Acknowledgements:   Neil Turner was the main author for this page. The last modified date is shown in the footer.

 

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