Daily problems involving contact with patients with terminal renal failure

Practitioners and physicians working in emergency rooms are often confronted with dialysis patients or patients who have received a kidney transplant. For dialysis patients, the mode of dialysis treatment needs to be assessed and dialysis access should be secured. Furthermore, the indications for the next dialysis treatment need to be determined. Dialysis patients often present themselves because of fluid overload, hypo- or hypertensive episodes, electrolyte disturbances, fever or cardiovascular events. Patients undergoing continous peritoneal dialysis are at an increased risk of infection of the catheter or of peritonitis. Patients with a renal transplant require continuation of their immunosuppression and the function of the transplant should be monitored. These patients often present with infections in which case the degree of immunosuppression may need to be reduced. Vaccinations as well as an increased risk for malignancies require special attention in these patients.