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Urgent Dialysis


Dialysis patients are perfect complex obs patients



Inclusion Criteria

  • These patients MUST have an established dialysis clinic to return to (or have a known social preclusion to having a clinic - eg. undocumented citizen or blacklisted from all clinics)
  • Interventional dialysis must be required
  • Discussion with nephrologist suggests 80% likelihood of needing a single dialysis treatment prior to discharge
  • Nephrologist agrees to expedite the dialysis of patient to facilitate discharge

Exclusion Criteria

  • Hypertension requiring continuous vasoactive medications
  • Concomitant febrile illness
  • No urgent indication for dialysis (ie not dyspneic, near-normal electrolytes)
  • No established clinic for further outpatient treatment

Potential Interventions

  • Continuous monitoring for arrhythmias due to electrolyte abnormalities
  • Serial exams and vital sign monitoring
  • Dialysis in 6-10 hours of unit arrival

Discharge Criteria

Home

    • Hemodialysis session has taken place
    • Repeat electrolytes show near normal values
    • Next session of hemodialysis arranged by either discussion with patient or by nursing

Admit

    • Altered mental status
    • New information suggesting that patient has no home dialysis clinic and will need placement into such clinic
    • Development of fever, unstable vital signs, consultant recommendation
    • Difficulties of vascular access during dialysis session or hypotension precluding completion


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