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|
|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