The Optimal Conduit for Hemodialysis Access
A 42-year-old type 1 diabetic of normal weight has recently progressed to chronic renal disease. Insulin-dependent diabetes mellitus (DM) has been managed by the same primary care physician for the preceding 12 years; glucose control has never been a problem in this cooperative and well-educated individual. The renal failure was initially managed with appropriate adjustments to diet and medications; the presumptive diagnosis is diabetic nephropathy. Recent laboratory tests demonstrate a creatinine of 4.1, a blood urea nitrogen of 94, a potassium of 4.8, mild proteinuria, and a creatinine clearance of 20 mL/min.
Refer the individual to a surgeon for hemoaccess.
Refer the individual to a nephrologist to refine diagnosis and initiate specialty care. It is not time to initiate dialysis.
Refer the individual to a nephrologist who will refine diagnosis, and determine if there is a...
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