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Medically Compromised Patient Care

Course Number: 628


There are two forms of dialysis, hemodialysis and peritoneal dialysis. Hemodialysis uses a dialyzer, which is an artificial filter that removes toxins, and is performed every other day for approximately 4-6 hours. These patients are usually given heparin, an anticoagulant, to help prevent blood clotting during the hemodialysis process. Peritoneal dialysis can be done at home via a catheter that is surgically implanted into the abdomen. It is usually performed 4 times a day and can cause acid reflux as a result, so these patients may prefer to be treated in a semi-supine position.

When considering how to modify dental treatment for patients with renal disease, a medical consult may be indicated to establish disease control and determine the possible need for antibiotic premedication due to a hemodialysis shunt. These patients can be treated safely with nitrous oxide and local anesthetic with vasoconstrictor. It is also helpful to schedule appointments on the day following dialysis, because the patient will be rested and the heparin effects are no longer in the body. When monitoring patient vitals make sure not to use the arm with the hemodialysis shunt. It is also important to check for excessive bleeding and review the lab results from the medical consult if available. Specifically, check the platelet count and platelet function analyzer (PFA-100) lab results. Given the potential for bleeding, aspirin and NSAIDs must be avoided; however, low doses of acetaminophen may be used. A frequent recall is helpful to prevent infections or identify them early.

In summary, if a patient presents to the dental office indicating they have chronic renal failure, there are several follow-up questions that are helpful to ask to determine the severity of the disease (Table 8).

Table 8. Follow-Up Questions for Chronic Renal Failure Patients(1)
  • When were you diagnosed with renal failure?
  • Are you currently receiving dialysis? If so, what type?
  • When was your last dialysis treatment?
  • Do you have a shunt, graft, catheter, or fistula? If so, where and when was it placed?