Haemodialysis

Part Two

Schematic diagram (8hrs x alternate nightly) = ‘Partial’ Nocturnal Haemodialysis

            Waste levels and blood volume fall slowly over each 8 hr NHHD (represented by the red bars) then rise again over the 40 hrs between each alternate night dialysis to continue through the next week on a ‘rolling’ basis

Schematic diagram (8hrs x 6 nights/wk) = Full Nocturnal Haemodialysis

            Waste levels and blood volume fall slowly over each 8 hr NHHD (represented by the red bars) then rise again over the 16 hrs between each nightly dialysis midweek and over 40 hrs one night/wk (allowing one night off in seven)

OK … so it is crunch-time … what then do I believe?

            4x3 HD is not ‘adequate’ HD … regardless of the ‘adequacy test’ used

            Longer and flexible dialysis regimens are essential

They should and must cater for:

            The needs, aspirations and tolerance of the individual

I believe that all dialysis units should offer ‘flexible dialysis’

            Flexible dialysis means a range of HD options from …

                        1. Conventional programs of 4x3 HD

            through to …

                        2. Full’ 6-7/wk NHHD

            and …

                        3. Short daily HD, 2nd (alternate) nightly HD and all other options in between

The ‘language of ‘the new dialysis’ …

…As newer dialysis options emerge, a new language has developed to embrace them …

            ‘Short daily’ - usually ~2hrs HD, 6 days/wk

            ‘Quotidian’ - means HD ‘every 24 hrs’:

            ‘Hemeral’ – during waking hours (i.e.. short daily HD) … but not a good word to use

            ‘Nocturnal’ – during sleep (i.e.. 6-7 nights/wk nocturnal HD)

            ‘Intermittent nocturnal’ – nocturnal HD 2nd nightly

            ‘High intensity’ – a good ‘term’ suggested by Chertow which embraces any option of increasing time and/or frequency

… So, after all that ‘pre-amble’, let us now focus on Nocturnal Haemodialysis