Preparing patients for RRT
The appropriate time to prepare someone for dialysis can be difficult to judge. It is essential that preparation should not be left until too late; it may, however, be inappropriate to burden people with this information too early.
- advise patients (and others e.g., spouse, as appropriate) re need for RRT
- introduce concepts of PD and HD early
- emphasise the importance of patients’ preference
- discuss transplantation (including pre-emptive transplantation)
- remember that no RRT is one option for management
About 6-12 months before expected ESRF, refer to:
- Social worker – download a proforma and copy of clinic letter (in Edinburgh)
- Community Dialysis Team: a written referral (In Edinburgh) (use downloadable proforma and copy
- clinic letter, including:
- Relevant PMH
- Any medical contraindications to PD/HD
- Very brief social history
- Urgency of referral
- Transplant team (unless clearly contraindicated) – see below for additional investigations required.
The CDT will arrange visits to see PD and HD (repeat if necessary), and will arrange invitation to a Patients’ Evening. They will see potential PD patients at home; those who are likely to do HD can be seen at clinic visits.
Get feedback from above visits/referrals, and at monthly Pre Dialysis MDT meeting check understanding.
Hepatitis B immunization should be carried out by request to patient’s GP (see antimicrobial policy).
AV access (fistula) should be created at least 6 months before starting HD to ensure that it is successful and mature. Some may require multiple operations.
- Refer to Vascular Access Coordinator (Ext 21199) and use specific referral performa.
CAPD catheter should be inserted at least 2 weeks before starting PD
- Operation dates are arranged through either the transplant or vascular surgical team. There is a coordinator for vascular access.
See below for blood tests required : Cytotoxic antibodies should be checked each OP visit for patients on the transplant list, or monthly.
Keep computer screens updated with dialysis/transplant decisions made, and other information requested. Liaise with consultants or computing staff if unclear how to do this.
New start on dialysis checklist
Click here for a checklist which may help when starting patients on dialysis. Consider using the checklist whenever a Permcath is inserted (either into new patients or existing dialysis patients).
Pre-dialysis and pre-transplant investigations
Proforma suitable for inserting into front of notes.
You can also download this proforma as a pdf file suitable for printing out and inserting into front of notes: click to download it now
|VIROLOGY||EBV is not routinely tested for but can be investigated on saved samples.|
|Hep B, C|
|IMMUNOLOGY||Measure CABs at each visit in patients on the transplant list (monthly for HD patients)|
|RADIOLOGY||No routine imaging of bones required pre-transplant, but PTH should have been measured. Surgical team may request pelvic XR in some.|
|UROLOGY||Pre-transplant, consider further investigation if history of recurrent infection, obstruction, or bladder dysfunction|
|CARDIOLOGY||Pre-transplant, echo mandatory if any history of cardiac disease, and refer if symptomatic or high risk|
|Other (eg ETT)||ETT mandatory if for SKP transplant|
|GASTRIC||If any symptoms or previous history to suggest increased risk of ulceration|
|Community dialysis team|
|Vasc. access/ PD cath|
Acknowledgements: Neil Turner was the main author for this page. The last modified date is shown in the footer.