5 Advanced chronic kidney disease
5.1 For patients who will be starting dialysis, continue to plan and carry out procedures to create vascular and peritoneal access. (See the NICE COVID-19 rapid guideline on arranging planned care in hospitals and diagnostic services for recommendations on elective care.)
5.2 Think about whether it is safe to delay starting dialysis during the COVD‑19 pandemic. Refer to the NICE COVID-19 rapid guideline on dialysis service delivery for details about how to do this.
5.3 Continue to refer patients for transplantation, if suitable, but explain that some of the tests and assessments need to be done in hospital and may be delayed during the COVID‑19 pandemic.
5.4 Ensure all patients with advanced CKD have had the opportunity to participate in advance care planning. This may include discussions about ceilings of treatment, conservative kidney management or end-of-life care, as well as making advance statements or advance decisions. Bear in mind that discussions may need to take place remotely. Document discussions and decisions clearly, and take account of these in planning care.