Preoperative Hemodialysis Timing in Patients With End-Stage Kidney Disease: The POD-ESKD Pilot Trial

Participants will participate in the study for approximately 2 months, including assessment of 30-day postoperative outcomes.

Inclusion criteria

• Patient is willing to comply with all study procedures for the duration of the study
• Patient has a diagnosis of ESKD
• Patient initiated hemodialysis at least 90 days prior to the planned surgical procedure
• Patient is treated with a stable hemodialysis schedule, defined as an average of 2.5- 3.5 hemodialysis sessions per week in the preceding 4 weeks prior to surgery
• Patient is scheduled to undergo nonemergent surgical procedures in the Stanford Health Care system. This includes (but is not limited to):

• Fistula or graft creation, revision, or removal
• Fistulogram
• Peritoneal dialysis catheter placement or revision
• Lower extremity angiogram (including femoral and iliac vessels)
• Lower extremity bypass (including femoral and iliac vessels)
• Lower extremity amputation
• Lower extremity endarterectomy (including femoral and iliac vessels) Of note, this list of procedures is not exhaustive and other procedures may be considered that meet inclusion criteria and no exclusion criteria, in consultation with the treatment teams involved.

Exclusion criteria

• Patient is pregnant
• Patient is a prisoner
• Patient is < 18 years old
• The treating clinicians determine that the patient's clinical condition necessitate a specific approach to surgical scheduling or preoperative hemodialysis