From the Guidelines
Nephrologists at dialysis sites provide comprehensive care to patients undergoing dialysis, and a referral from a primary care provider is typically required for concurrent care, especially for patients with advanced kidney disease or complex management issues. When considering the management of patients with kidney disease, it is essential to involve nephrologists, especially when there is uncertainty about the etiology of kidney disease, difficult management issues, or advanced kidney disease requiring discussion of renal replacement therapy for end-stage renal disease (ESRD) 1. The role of nephrologists in dialysis care includes managing the dialysis prescription, monitoring patients' response to treatment, adjusting medications, and addressing complications related to kidney disease. Key aspects of their care include:
- Managing blood pressure and blood glucose to slow the progression of kidney disease
- Discussing the potential need for renal replacement therapy
- Prescribing medications such as phosphate binders, erythropoietin-stimulating agents for anemia, and vitamin D analogs
- Collaborating with primary care providers to manage other health conditions This collaborative approach is crucial for dialysis patients, who often have complex medical needs requiring specialized knowledge of fluid balance, electrolyte management, and dialysis-specific complications that nephrologists are specifically trained to handle, as highlighted in the standards of medical care in diabetes-2022 1.
From the Research
Nephrologist's Role in Dialysis Treatment
- Nephrologists are responsible for ordering dialysis treatments and making decisions about patient care 2.
- There is no indication that patients require a referral from their primary care provider (PCP) to a nephrologist for concurrent care while undergoing dialysis.
Care of Dialysis Patients
- Non-nephrologists may provide care to hospitalized hemodialysis patients, but they may not receive specialized training to do so 3.
- Nephrologists play a crucial role in managing the care of patients with end-stage renal disease (ESRD) and those undergoing hemodialysis.
Management of Anemia in Dialysis Patients
- Nephrologists are involved in the management of anemia in chronic kidney disease and dialysis patients, including the use of erythropoietin-stimulating agents and iron supplementation 4, 5, 6.
- The management of anemia in dialysis patients may involve individualized treatment plans and the use of novel therapies, such as iron-based phosphate binders and dialysate iron delivery.