Equipment and water treatment considerations for the provision of quotidian home hemodialysis

Home nocturnal hemodialysis in children

“…13, 14 Vascular access was provided initially with central venous lines (CVL) in all 4 patients and, subsequently, arteriovenous (AV) fistulae in 2 patients. During NHD, central venous lines are held in place with a locking device described by Pierratos.…”

A systematic review of the effect of nocturnal hemodialysis on blood pressure, left ventricular hypertrophy, anemia, mineral metabolism, and health-related quality of life

“…1), 71 of which were found to be relevant to nocturnal dialysis. Of these, 7 papers and 1 abstract were based on thrice weekly NHD [5][6][7][8][9][10][11], 2 papers were case reports [12,13], 16 papers and 2 abstracts did not report information on the clinical end points of interest [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], and 29 were either reviews, editorials, solely qualitative in nature, or contained previously published subsets of data . The remaining 10 papers and 4 abstracts were included in the systematic review [59-68, ].…”

Technical Requirements of a Home Hemodialysis Program

“…These requirements should be created and outlined by biomedical/clinical engineering and hospital personnel with experience in planning and facilities development, and they should incorporate numerous components of home hemodialysis installation, including an assessment of the dwelling, installation planning, home renovation, and equipment installation [2]. Development of a detailed checklist of the critical parameters helps to identify services that may require upgrading prior to installation planning (table 1).…”

“…It is recommended that a hospital architect or biomedical/clinical engineering specialist first conduct a home visit to assess water, sewage, electricity, and space. It is typically necessary for a new hemodialysis patient's home to undergo some level of renovation before home hemodialysis can begin; thus, a program policy outlining the contracting, coordination, and monitoring of any home renovations should first be developed [2]. A policy that addresses the removal of hemodialysis equipment should also be developed in the event that a patient returns to an in-center program, no longer needs home therapy (i.e., in the case of a successful kidney transplant), or expires.…”

“…Lower blood flow rates -typically 200 ml/min -and dialysate flow rates of 100-200 ml/min are necessary to support long, slow nocturnal dialysis treatments [2]. Nocturnal hemodialysis patients also benefit from machines designed to provide maximum comfort so that the patient can sleep through each dialysis session.…”