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 that ‘pre-amble’, let us now focus on Nocturnal Haemodialysis