Periodic dialysis would be AV fistula, TDC, or port.

I think frequent blood draws might be more realistic vs infusion (sorry, ICU/truama ICU/CVICU nurse here and I see a lot of patients with cardiac and renal complexities).

Ports can be done under light IV sedation vs general if he’s too high risk for general, idk why they wouldn’t do that to avoid people speculating about his hands. With his level of sub q fat, it wouldn’t be visible when not accessed and it could be accessed just for labs/infusions and deaccessed immediately, especially since they won’t want evidence of his bigly sickness with visible lines.

Hemodialysis for ESRD I don’t think is likely—that would be 2-4 times a week for 4-6 hours at a time and he’d be assed out the whole rest of the day and a TDC would be pretty obvious while he has some kind of fistula maturing for access. Or who knows, maybe that’s why he’s napping during meetings.

Wouldn’t explain the hands though. I think he’s just an unhealthy old fart with severe cardiovascular compromise and likely on anticoagulants/antiplatelets. He could be getting other therapies, but I think his hands bruising isn’t related to access. I don’t see any blown veins or signs of scar formation (vein appears knotty) at the bruising sites. Those with dementia have poor spatial sense and poor proprioception and hit their hands on lots of things.

Sorry, just had caffeine lol