Documenting a nephrology round
Dialysis reviews with target weight, bloods and access, renal clinic notes, and letters to the GP and transplant unit.
A haemodialysis review at the chair
Haemodialysis Monday, Wednesday, Friday, four hours, left brachiocephalic fistula.
Interdialytic gain 3.4 kilos. Pre BP 162/90, post 128/76. Cramping in the last hour. Keep the target weight at 72.5. Extend to four and a half hours to bring the UF rate down, and see the dietitian about fluid and salt.
Pre-dialysis potassium 6.1, phosphate 2.1, corrected calcium 2.32, PTH 48.
Hb 98 on darbepoetin 40 weekly, ferritin 420, TSAT 24. Increase darbepoetin to 60.
Start sevelamer 800 TDS with meals. Dietitian for potassium and phosphate, and I've reviewed the dialysate potassium.
Fistula good thrill and bruit, no prolonged bleeding.
Prescription
HD MWF, 4 h, L brachiocephalic AVF.
Fluid
IDWG 3.4 kg. Pre BP 162/90, post 128/76. Cramps in final hour. Target weight unchanged at 72.5 kg. Session extended to 4.5 h to lower the UF rate. Fluid and salt restriction reinforced.
Bloods
K 6.1, PO4 2.1, corrected Ca 2.32, PTH 48. Hb 98, ferritin 420, TSAT 24%.
Changes
- Darbepoetin 40 to 60 mcg weekly
- Sevelamer 800 mg TDS with meals
- Dietitian review: potassium, phosphate, fluid and salt
- Dialysate potassium reviewed
- HD time 4 to 4.5 h
Access
AVF: good thrill and bruit. No prolonged bleeding post needling.
Letters
- Letter to the GP
- Dose changes, the new binder, the potassium result and the diet advice given.
- Letter to the transplant unit
- Current status, recent bloods, sensitising events and any change to fitness for listing.
