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