Renal & Hepatic
Dental Management of Patients with Renal failure / dialysis
Schedule the day after dialysis; avoid nephrotoxic drugs
Dialysis patients have platelet dysfunction (bleeding tendency) and altered drug handling. Treat on a non-dialysis day (best the day after).
Emergency vs routine management
If EMERGENCY — what to do
- • Treat on a non-dialysis day (ideally the day after dialysis) — residual heparin effect on dialysis day.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • Never take BP or cannulate on the fistula arm.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • Avoid NSAIDs and nephrotoxic drugs; adjust antibiotic dosing to eGFR (e.g. extend amoxicillin interval).Ref: British National Formulary (BNF) — Prescribing in renal impairment, hepatic impairment & drug interactions (current edition)
If ROUTINE — what to do
- • Liaise with the nephrologist; book the day after dialysis.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • Dose-adjust all prescriptions to renal function.Ref: British National Formulary (BNF) — Prescribing in renal impairment, hepatic impairment & drug interactions (current edition)
Clinical precautions
- • Treat the day after dialysis (not on dialysis day)
- • Avoid NSAIDs and nephrotoxic drugs; adjust drug doses to renal function
- • Local haemostatic measures
- • Consider endocarditis risk if AV fistula/line — assess per AHA
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | MODIFY / CAUTION Schedule the day after dialysis; avoid nephrotoxic drugs |
| Supragingival scaling / polish | MODIFY / CAUTION Schedule the day after dialysis; avoid nephrotoxic drugs |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Schedule the day after dialysis; avoid nephrotoxic drugs |
| Root canal treatment | MODIFY / CAUTION Schedule the day after dialysis; avoid nephrotoxic drugs |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Schedule the day after dialysis; avoid nephrotoxic drugs |
| Surgical / bony extraction | MODIFY / CAUTION Schedule the day after dialysis; avoid nephrotoxic drugs |
| Implant placement | MODIFY / CAUTION Schedule the day after dialysis; avoid nephrotoxic drugs |
References
- Renal disease & dialysis — dental management
- Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- British National Formulary (BNF) — Prescribing in renal impairment, hepatic impairment & drug interactions (current edition)
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.