ESRD

Diagnosis Diagnosis
- When where you diagnosed?
- How many years have you had kidney problem?
- What is the cause of kidney problem?
- Can you tell me how were you diagnosed with CKD? AKI/ pick up on blood test
- What symptoms did you had? Blood in urine/frothy urine, were you not producing any urine or
was it an incidental finding on a blood test?

Possible causes: HTN, DM, GN (SLE, vasculitis), PCKD, Obstruction: Prostate problem/stones
Recent
events
Baseline  Urinary symptoms  Anaemia
“Over the - Frothy urine, oliguria, anuria -fatigue, SOB
years do you  Uraemia  Fluid overload
develop any - Nausea and vomitting - Leg swelling
symptoms?” - Malaise/fatigue - Dyspnoea
- Pruritis - Orthopnea
- PND
Monitoring Clinic
- Who look after your kidney?
- When was your recent clinic day?
- Do you know your baseline creatinine?
- Any protein in the urine when they dip your urine?
- BP reading recently? Measure at home? What is the value?
Treatment &  What treatment have you had for your kidney? TRANSPLANT
Complication - How long have you been on dialysis - Are you listed from transplant?
Any plan for transplant in the
HAEMODIALYSIS future?
- How many times per week do they dialyse and how - When was transplant performed?
many hours is each treatment? 
 From live donor or deceased
- What is the patient’s current access for dialysis (e.g. donor?
an arteriovenous 
 fistula, a PTFE graft, or a - What immunosupression are you
tunnelled dialysis taking?
- catheter)? 
 1. MMF [mycolat]
- Any issue with the fistula so far? Infection or 2. Tacrolimus (Prograf)
blockage? 3. Prednisolone
- Do you know your BP at the end of session? 4. Septrin/Valganciclovir
BOTH
 5. PPI/Ranitine???
 How much urine do they pass, if any?
 - Have you had any rejection
 What is their dry (aka flesh, target, post-dialysis) period?
weight?
 - What mode of dialysis you were
 What is their daily fluid allowance?
 on prior to transplant?
 Do they adhere to a renal diet?

 Do they receive erythropoietin injections? Who Transplant related
performs these? - Previous skin cancer, blood
 Have they always been on the same modality of cancer, cervical cancer
dialysis?
 - Opportunistic infection: BK
virus, CMV, PCP pneumonia
 Are they ‘listed’ for deceased donor
- Rejection episode?
transplantation?

- hyperPTH
 Have they previously received a transplant?
 How are they coping with dialysis? 
 ELECTROLYTE ABNORMALITIES
- uric acid: allopurinol
PERITONEAL DIALYSIS
 Do you do them overnight or during the day? CARDIOVASCULAR DISEASE
 How many exchanges do they perform? 
 - Any heart issue? Chest pain or
 How many litres is each exchange? 
 heart attack? pericarditis
 Do they need assistance to perform an exchange? 
 - Are you on aspirin or statin
 Do they measure their own blood pressure at home? - Fluid overload?
What have the readings been recently? 

 Is the exit site of their dialysis catheter clean and
dry? 

 Are the dialysis bags clear or cloudy on drainage? 

 When was their last episode of peritonitis?
 Ever experience any fluid leak?
 RENAL ANAEMIA BONE DISEASE
- EPO injection Bone density affected by your kidney?
- Iron & folic acid Any report of high calcium or low
calcium
- Bone protection: calcium & Vit
D
- Cinacalcet
- Parathyroid sx?
- Phosphate binder [sevelamir]