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1. Indications for dialysis - advancing uremia with any uremic symptoms in a patient with a CrCI < 15 mL/min.

2. Hemodialysis: A forearm AV fistula lasts the longest but should be created several months before dialysis; otherwise, a tunneled dialysis catheter or arteriovenous graft is needed. Refer patients when they develop stage IV CKD (GFR < 30).

3. Mortality in dialysis from cardiovascular disease, infection. Morbidity from thrombosis/infection of the vascular access.

4. Dialysis patients have anemia, high triglycerides, and a low HDL. They usually have a metabolic acidosis just before and a respiratory alkalosis just after dialysis.

5. Maintain adequate nutrition, vitamin supplements are indicated, especially water-soluble and folate, which are lost daily.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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