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
Authored by Prof
John Agar. Copyright © 2012
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