Patient with Severe End-Stage Renal Disease Stages (4-5) Presenting for Surgical Periodontal Therapy.

Patients with ESRD have an increased risk of bleeding owing to platelet dysfunction associated with uremia. It is important to obtain coagulation tests and complete blood count before the surgical procedure, and abnormal values should be discussed with the patient's physician. A conservative surgical technique must be followed to decrease the risk of bleeding and infection. The dentist should ensure the availability of local hemostatic agents at the dental office to be used as needed to obtain hemostasis. Following the medical complexity status (MCS) system, the patient can be designated as MCS 2B category.