Management of Common Medical Conditions in End-Stage Kidney Disease by the General Practitioner

Objective: Patients with end-stage kidney disease (ESKD) represent a clinical challenge when it comes to the management of certain medical problems, and successful management of these patients requires substantial knowledge of their unique condition. This article presents a review of some aspects of ESKD that are less clear among general practitioners.

Methods: We conducted a clinical survey for 200 physicians and practitioners in a community hospital setting to explore how general practitioners would manage certain medical problems in ESKD patients.

Results: 75% of respondents considered intravenous fluid administration for the treatment of diabetic keto-acidosis in anuric ESKD patients although they are protected from hypovolemia resulting from osmotic diuresis; 47% considered potentially nephrotoxic agents safe in peritoneal dialysis patients with residual kidney function; and 31% chose immediate dialysis following the exposure to an intravenous iodine contrast in anuric ESKD patients. We searched the literature for the available evidence in the management of these issues along with other medical problems that general practitioners encounter.

Conclusion: Certain concepts in ESKD maybe less clear among general practitioners: 1) Anuric ESKD patients with diabetic hyperglycemic emergencies are protected from osmotic diuresis-induced hypovolemia; 2) Peritoneal dialysis patients with residual kidney function should not be treated similar to anuric ESKD patients in regards to nephrotoxic agent administration; and 3) Intravenous iodine contrast carries no potential risk in anuric end-stage kidney disease patients and immediate removal by dialysis is not warranted. Successful management of ESKD patients requires substantial knowledge of their unique condition and effective communication between medical staff and nephrologists.

Cite this article as: El-Alali E, Al-Jaber E. Management of common medical conditions in end-stage kidney disease by the general practitioner. Turk J Nephrol. 2023;32(1):30-38.