Guiding Priniciple:

Edema is common in patients with ESKD. Edema in tissues can impact circulation, mobility, quality of life and wound healing. Pulmonary edema occurs when a patient is intravascularly volume overloaded; this can exacerbate the patient’s sensation of shortness of breath. Note that interventional guidelines do not replace individualized care and clinical expertise.

  • Peripheral arterial insufficiency
  • Heart failure
  • Liver failure
  • Severe skin conditions
  • Thrombosis
  • Lack of exercise
  • Previous injury or surgical intervention
  • Lymphedema
  • Hypoalbumenia
  • Malnutrition
  • Medication (eg. amlodipine (Norvasc), sodium bicarbonate, sodium polystyrene (Kalexate))
  • Encourage patients to elevate their edematous extremities above their heart whenever seated.
  • Consider compression therapy (e.g. wraps and pressure gradient stockings).
  • Encourage movement, as appropriate, to recirculate fluid.
  • Consider dietary salt restrictions (if volume overloaded) (See: Sodium/Fluid Statement).
  • Consider fluid restrictions (if volume overloaded).
  • Consider regular weight and blood pressure measurements to help regulate volume.
  • Consider a referral to physiotherapy and/or occupational therapy for support with edema management.
  • See: Swelling Patient Handout

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