Routine and emergency management guidelines for the dental patient with renal disease and kidney transplant part 2

In the dental management of renal patients, liaison with the consultant nephrologist pre-operatively is of paramount importance. The extent of the planned dental treatment, potential surgical problems that might be encountered and the likely morbidity the patient may experience must be assessed. The names and doses of the planned drugs should also be communicated to the nephrology team. This will allow them to verify appropriateness of drug doses or suggest modifications, if necessary.

The special care practitioner may consider that some patients in end stage renal failure should have their oral care provided in a theatre environment where they can be monitored more closely by the medical team. Additionally, anxiety management strategy should be considered for renal patients. Discussion with a consultant anaesthetist, ideally the one who will be present at the time of treatment, should be part of the planning process.

Dialysis fistulas and grafts should be protected against pressure during lengthy interventions or general anaesthesia; they should not be used for vascular access unless in an emergency, for example, a cardiac arrest. Patients already on dialysis may benefit from observation overnight and arrangements must be made for their dialysis treatment whilst in hospital. Patients on peritoneal dialysis (PD) may be unable to perform the dialysis themselves if compromised by sedation and analgesia, and will therefore need assistance.