From the Guidelines
A comprehensive pre-dialysis assessment should be based on a composite evaluation of the patient's symptoms, signs, quality of life, preferences, level of GFR, and laboratory abnormalities, as recommended by the most recent guidelines 1. The evaluation process for pre-dialysis assessment involves a thorough review of the patient's medical history, physical examination, and laboratory results.
- Vital signs, including blood pressure, heart rate, temperature, respiratory rate, and weight, should be assessed to establish baseline parameters and detect potential complications.
- The access site, whether a fistula, graft, or catheter, should be examined for signs of infection, patency, and proper function.
- Laboratory values, such as electrolytes, blood urea nitrogen, creatinine, complete blood count, and coagulation studies, should be reviewed to identify any abnormalities that may impact dialysis treatment.
- Medication reconciliation is crucial to identify drugs that may require dose adjustments or should be held before dialysis, such as antihypertensives that may cause hypotension during treatment.
- The patient's fluid status should be assessed by checking for edema, shortness of breath, or other signs of fluid overload, and their interdialytic weight gain should be reviewed.
- A brief neurological assessment and evaluation of the patient's understanding of their treatment plan should also be completed. This comprehensive approach ensures safe and effective dialysis treatment while preventing complications, as supported by the latest guidelines 1. The initiation of dialysis should be based on a composite assessment of the patient's symptoms, signs, quality of life, preferences, level of GFR, and laboratory abnormalities, as stated in the KDOQI US commentary on the KDIGO 2024 clinical practice guideline for the evaluation and management of CKD 1. It is essential to prioritize the patient's quality of life, preferences, and symptoms when making decisions about dialysis treatment, rather than relying solely on laboratory values or GFR levels 1.
From the Research
Pre-Dialysis Assessment Evaluation Process
The evaluation process for pre-dialysis assessment involves several key components, including:
- Comprehensive holistic nursing assessment 2
- Timely and appropriate patient education 2, 3
- Evaluation of the patient's physical and mental conditions to determine the suitability of dialysis treatment 4
- Assessment of the patient's glomerular filtration rate (eGFR) to predict the need for dialysis within a certain timeframe 5
- Shared decision-making between the patient and healthcare provider to determine the best course of treatment 4, 6
Key Factors in Pre-Dialysis Assessment
Some key factors to consider in the pre-dialysis assessment evaluation process include:
- The patient's age and comorbidities 4, 5
- The patient's eGFR and estimated time to dialysis 5
- The patient's physical and mental ability to undergo dialysis treatment 4
- The patient's access to nephrology care and kidney replacement therapy (KRT)-directed education 6
- The patient's awareness of their kidney disease and its severity 6
Healthcare Provider Involvement
Healthcare providers play a crucial role in the pre-dialysis assessment evaluation process, including:
- Nephrologists, who can predict the need for dialysis within a certain timeframe 5
- Renal nurses, who can provide comprehensive holistic nursing assessments and patient education 2, 3
- Multidisciplinary teams, including dietitians, physiotherapists, psychologists, and social workers, who can provide support and guidance to patients and their families 3, 4