Kidney/Renal Disease - Oral Health Care Considerations

Consult the patient’s nephrologist about the severity of kidney disease. Also, see relevant laboratory values that may suggest renal failure.
Address any underlying medical condition or disease. Increased risk of cardiac arrest and heart failure (HF).
⚠️ Do not measure blood pressure in the arm with vascular access in patients with hemodialysis.
If possible, treat hemodialysis patients on days they are not receiving hemodialysis.
Be aware of possible increased bleeding tendencies.
Antibiotic prophylaxis is only indicated if a hemodialysis patient has a history of previous infective endocarditis.
No special dental modifications necessary for patients with peritoneal dialysis.
⚠️ Avoid using aminoglycosides, tetracyclines, cephalosporins, and ibuprofen.
⚠️ Change the dosage regimen for aspirin to q 4-6 h.
⚠️ Change the dosage regimen for amoxicillin according to a patient’s creatinine clearance (CrCl):
- CrCl >30 ml/min – no adjustment needed;
- CrCl 10-30 ml/min – 250-500 mg PO every 12 h, do not use 875 mg tablet strength or the extended release tabs;
- CrCl <10 ml/min – 250-500 mg PO every 24 h, do not use 875 mg tablet strength or the extended release tabs.

Medical Complexity Status - Kidney/Renal Disease#

See Medical Complexity Status for more information.

References
- Parsegian K, Trivedi R, Ioannidou E. Renal diseases. In: Glick M, Greenberg MS, Lockhart PB, Challacombe SJ, eds. Burket’s Oral Medicine. 13th ed. Wiley-Blackwell; 2021.
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