Hemodialysis: Initiation and complications

Abstract

A 60-year-old man with Stage V chronic kidney disease due to biopsy-proven diabetic and hypertensive nephropathy presents to clinic for a routine visit. His estimated glomerular filtration rate is 10 ml/min/1.73 m 2 and his blood pressure is 145/80 mmHg. Laboratory studies demonstrate potassium 4.9 mEq/L, total CO 2 19 mEq/L, phosphorus 5.0 mg/dL, and hemoglobin 10.5 g/dL. He feels well without weight loss, anorexia, or nausea. He is reluctant to have an arteriovenous fistula placed, and he does not wish to initiate hemodialysis. The patient desires to know the optimal time to initiate dialysis. If he requires dialysis initiation through a tunneled dialysis catheter, what measures can be taken to reduce his risk for catheter infection?