A Visual Protocol for Selecting, Initiating, and Monitoring Hemodialysis or Peritoneal Dialysis in Adults with Uremic-Stage Chronic Kidney Disease.

Uremic-stage chronic kidney disease requires timely kidney replacement therapy, but the transition from advanced chronic kidney disease to hemodialysis (HD) or peritoneal dialysis (PD) is often fragmented. Late referral, incomplete modality education, delayed access planning, and insufficient early follow-up contribute to avoidable urgent starts, catheter exposure, hospitalization, and poor patient experience. This article describes a reproducible, visually demonstrable transition-care protocol for a hospital-based adult nephrology service. The workflow moves from eligibility screening and clinical urgency classification through balanced modality education, teach-back verification, and shared decision-making to modality-specific access planning, initiation, and early safety monitoring, and concludes with a monthly quality-improvement audit. Reviews at 7, 30, and 90 days feed a small set of predefined fidelity indicators back into that audit loop. The actions that can be filmed directly are completing the triage form, applying the modality decision matrix, verifying teach-back, working through the HD or PD initiation checklist, and reviewing the monthly quality dashboard. Implementation is illustrated with a locked, de-identified single-center dataset of 345 consecutive incident dialysis starts (305 HD, 40 PD), used to demonstrate protocol fidelity, access distribution, and early descriptive outcomes. The protocol is intended to make variation, emergency starts, access delays, and early complications visible and auditable. It is not a randomized comparison of HD and PD, it does not establish the superiority of either modality, and it does not replace clinical guidelines.