OET letter for a kidney (renal) patient: dialysis, fluid limits and blood results
In an OET Nursing letter about a kidney patient, give the reason for admission and current condition, then the details the reader must act on: the dialysis schedule and access site, any fluid or diet limits, medicine changes, and the blood tests that need repeating. Summarise kidney results as a change or a single value that matters instead of copying every result, and end with a request that matches those needs.
What the reader needs from a renal letter
Kidney case notes are dense. You may see creatinine and potassium every day, fluid balance totals, dialysis times, weights before and after dialysis, blood pressure and a long medicine list. The reader of your letter, often a community nurse, a dialysis unit, a GP or a residential facility, needs a short picture of the patient and a clear plan.
Before you write, answer four questions from the notes:
- Why was the patient admitted, and how are they now?
- Is the patient on dialysis? If so, where, how often, and what access do they have (fistula, line, catheter for peritoneal dialysis)?
- What limits apply? Fluid, potassium, salt or phosphate in the diet.
- What must be rechecked or changed? A repeat blood test, a medicine adjustment, an appointment.
Everything else is background. For the general method, see how to select case notes.
What to include and what to leave out
| Usually include | Usually leave out |
|---|---|
| Reason for admission in one sentence | Each daily blood result |
| Current kidney function as a trend ("has improved", "remains reduced") | Results that are normal and need no action |
| Dialysis type, days and unit | Exact dialysis start and finish times |
| Access site and any precautions (no blood pressure on that arm) | Details of how the access was created years ago |
| Fluid limit and diet advice in plain words | Full fluid balance charts |
| New, stopped or changed medicines | Unchanged medicines unrelated to the plan |
| Blood tests to repeat and when | Ward routines |
| Patient's understanding, mood and support at home | Unrelated hobbies or distant history |
Turning renal notes into sentences
| Notes | Letter sentence |
|---|---|
| Adm AKI on CKD 3, creat 312 → 168 | "He was admitted with a sudden decline in his kidney function, which has since improved." |
| HD Mon/Wed/Fri, Riverside Unit | "He receives haemodialysis at the Riverside Unit on Mondays, Wednesdays and Fridays." |
| L forearm AVF – no BP/bloods L arm | "He has a fistula in his left forearm, so blood pressure and blood samples should be taken from his right arm only." |
| FR 1 L/day, low K diet | "He has been advised to drink no more than one litre a day and to limit foods high in potassium." |
| K+ 6.1 on adm, 4.8 today; recheck 3/7 | "His potassium was high on admission but is now 4.8 mmol/L and should be rechecked in three days." |
| Ramipril withheld – review GP | "His ramipril has been withheld and should be reviewed by his GP." |
| Pt tired post HD, wife anxious | "He is tired after dialysis sessions, and his wife is anxious about managing at home." |
Copy units, doses and limits exactly. "One litre" must not become "a small amount". If you are unsure how to lay out numbers, see vital signs and test results in letters and medications in OET letters.
Choosing the trend over the number
A trend is often clearer than a value. "His kidney function has improved but remains below his usual level" tells a community nurse more than "creatinine 168 µmol/L (baseline 140)". Use a number when the reader needs it to act: a potassium they must recheck, a weight target, a fluid limit. If the notes give a target dry weight or a weight gain that should prompt contact, include it.
Adjusting for the reader
- Dialysis unit: reason for the admission, changes to medicines, current weight, access problems, blood results they will compare.
- Community nurse: fluid limit, access care, what to observe (swelling, breathlessness, weight), blood test due, education needs.
- GP: medicines withheld or changed, results to recheck, follow-up appointments.
- Patient or family: plain words, practical limits, warning signs and who to call. See writing to a non-clinical reader.
Worked example (invented case)
Case summary (invented): Mr Tomasz Nowak, 67, retired bus driver, lives with wife in a house with stairs. Admitted 3 June with vomiting, reduced urine and confusion. Background: chronic kidney disease, type 2 diabetes, high blood pressure. Kidney function dropped suddenly on admission; improved with fluids and stopping ramipril. Started haemodialysis during admission as kidney function had been worsening over the past year; now attends Riverside Dialysis Unit Mon/Wed/Fri. Fistula left forearm, created 5 June, not yet in use; dialysis via neck line. Potassium 6.1 on admission, 4.8 today; recheck in 3 days. Fluid limit 1 L/day; low-potassium diet, seen by dietitian. Ramipril withheld; GP to review. Tired after dialysis. Wife anxious. Enjoys fishing. Appendix removed 1978. Discharge 14 June. Task: write to the community nurse.
Selection decisions:
- In: reason for admission and current state, new dialysis schedule and unit, the neck line and new fistula with precautions, potassium recheck, fluid and diet limits, ramipril withheld, tiredness and anxious wife.
- Out: fishing, appendix, daily creatinine values, admission observations.
Sample letter body:
Dear Community Nurse,
Re: Mr Tomasz Nowak, aged 67
I am writing to refer Mr Nowak, who is being discharged home today after starting haemodialysis, for monitoring and support at home.
Mr Nowak was admitted on 3 June with vomiting, reduced urine output and confusion caused by a sudden decline in his kidney function. His condition has improved, but his long-standing chronic kidney disease has progressed, and he now attends the Riverside Dialysis Unit on Mondays, Wednesdays and Fridays. Dialysis is currently given through a line in his neck. A fistula was created in his left forearm on 5 June and is not yet in use, so blood pressure and blood samples should not be taken from that arm.
His potassium was high on admission but is now 4.8 mmol/L and should be rechecked in three days. He has been advised to drink no more than one litre a day and to follow a low-potassium diet. His ramipril has been withheld until his GP reviews it.
Mr Nowak feels tired after dialysis, and his wife is anxious about managing at home.
I would be grateful if you could check his neck line and fistula, arrange the potassium test and support him and his wife with the fluid limit. Please do not hesitate to contact me if you require further information.
Yours sincerely,
Notice that the letter gives one potassium value with a recheck date, not a week of results, and that the request covers the line, the blood test and the family's worry raised earlier.
Practise a full case under timed conditions at /writing/, or check a letter you have written for an estimated mark on each of the six criteria.
Mistakes to avoid
- Copying the results table. Give a trend and only the values the reader acts on.
- Forgetting access precautions. "No blood pressure on the fistula arm" is a safety point the reader needs.
- Leaving out the dialysis days. A carer or nurse planning visits needs them.
- Renal shorthand. AVF, HD and FR are unclear outside a renal ward.
- A request disconnected from the body. If you mention a blood test due, ask the reader to arrange it.
Related: heart failure patient letters (similar fluid and weight issues), discharge and transfer letters and conciseness and clarity.
Sources
This guide is medEmu's writing advice, not official OET guidance or clinical advice; all patients, medicines, results and limits are invented for practice and must not be used to guide care. The network used for this run could not reach oet.com, so no OET test facts are stated beyond the criterion names. For OET's official Writing information, see oet.com.