Renal Replacement Therapy (Haemodialysis, Peritoneal Dialysis) — Viva Defence

Opening statement (SASPOP, delivered aloud)

"Mrs Nguyen is a 67-year-old woman with CKD5 from hypertension and diabetes, an eGFR of 8 on a clear downward trajectory, and two facts that dominate every decision: ischaemic heart disease with a borderline ejection fraction — because cardiovascular disease is what kills dialysis patients and haemodialysis is itself a cardiac stress — and emerging frailty, which reshapes what any therapy can achieve. She is currently asymptomatic from her kidneys, so per the IDEAL evidence she does not need to start dialysis today; but her planning window is closing, and it has not yet been used. Her main problems are: advanced CKD needing a modality decision within months, not weeks; cardiovascular disease that both disqualifies her from transplant listing until assessed and makes intradialytic hypotension genuinely dangerous; frailty and dependence that must shape the modality and the goals conversation; and an unstarted access plan. My plan is to complete cardiac and frailty assessment, run the modality conversation honestly — assisted peritoneal dialysis at home versus supervised in-centre haemodialysis versus a structured conservative pathway — create access in time for the anticipated start, and integrate her stated priorities: time at home with her husband is the outcome she is actually buying." ^{[1] [10] [7]}