Hemodialysis

Patients who are end stage renal disease patients on either Hemodialysis (HD) or Peritoneal Dialysis (PD) can be cared for in ED Observation for appropriate problems as long as they do not require dialysis during their stay.

All such patients should have a basic chemistry panel before being placed in ED Obs. Patients can often miss one dialysis session or have their next outpatient dialysis session rescheduled to accommodate time in ED Observation without any untoward consequences. When deciding if such a patient can come to ED obs, consider the time from last dialysis, their fluid status, BUN, bicarb and potassium levels. Relative contraindications to keep such a patient in ED Obs would be uncontrolled hypertension, new shortness of breath or oxygen requirement, potassium above 6.0, Bicarb < 15, and BUN > 80. If you are not sure, it is fine to discuss with Nephrology before placing or accepting a patient into ED observation.

At this time patients who require Hemodialysis while in the hospital cannot be cared for in ED Observation.

We are hoping to change this, however there are several barriers that remain until this is possible. So stay tuned.