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.
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advise patients (and others e.g., spouse, as appropriate) re need for RRT |
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introduce concepts of PD and HD early |
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emphasise the importance of patients' preference |
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discuss transplantation (including pre-emptive transplantation) |
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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.
Data Accuracy
Keep computer screens updated with dialysis/translplant decisions made, and other information requested. Liaise with consultants or computing staff if unclear how to do this.
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
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Test
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dialysis |
transplant |
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VIROLOGY |
EBV is not routinely tested for but can be investigated on saved samples. | |||
| Hep B, C | ||||
| HIV | ||||
| CMV | ||||
| VZV, EBV | ||||
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IMMUNOLOGY |
Measure CABs at each visit in patients on the transplant list (monthly for HD patients) | |||
| Tissue typing | ||||
| Cytotoxic antibodies | ||||
| Blood group | ||||
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RADIOLOGY |
No routine imaging of bones required pre-transplant, but PTH should have been measured. Surgical team may request pelvic XR in some. | |||
| CXR | ||||
| Renal imaging | ||||
| Other | ||||
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UROLOGY |
Pre-transplant, consider further investigation if history of recurrent infection, obstruction, or bladder dysfunction |
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CARDIOLOGY |
Pre-transplant, echo mandatory if any history of cardiac disease, and refer if symptomatic or high risk | |||
| ECG | ||||
| Echo | ||||
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Other (eg ETT) |
ETT mandatory if for SKP transplant | |||
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GASTRIC |
If any symptoms or previous history to suggest increased risk of ulceration |
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Endoscopy |
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REFERRALS |
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Community dialysis team |
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| Social assessment | ||||
| Vasc. access/ PD cath | ||||
| Transplant team | ||||
Acknowledgements: Neil Turner was the main author for this page, last amended Thursday, November 30, 2006.
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