Renal Association Clinical Practice Guideline on Haemodialysis

Abstract

This guideline is written primarily for doctors and nurses working in dialysis units and related areas of medicine in the UK, and is an update of a previous version written in 2009. It aims to provide guidance on how to look after patients and how to run dialysis units, and provides standards which units should in general aim to achieve. We would not advise patients to interpret the guideline as a rulebook, but perhaps to answer the question: “what does good quality haemodialysis look like?”The guideline is split into sections: each begins with a few statements which are graded by strength (1 is a firm recommendation, 2 is more like a sensible suggestion), and the type of research available to back up the statement, ranging from A (good quality trials so we are pretty sure this is right) to D (more like the opinion of experts than known for sure). After the statements there is a short summary explaining why we think this, often including a discussion of some of the most helpful research. There is then a list of the most important medical articles so that you can read further if you want to – most of this is freely available online, at least in summary form.A few notes on the individual sections: This section is about how much dialysis a patient should have. The effectiveness of dialysis varies between patients because of differences in body size and age etc., so different people need different amounts, and this section gives guidance on what defines “enough” dialysis and how to make sure each person is getting that. Quite a bit of this section is very technical, for example, the term “eKt/V” is often used: this is a calculation based on blood tests before and after dialysis, which measures the effectiveness of a single dialysis session in a particular patient.This section deals with “non-standard” dialysis, which basically means anything other than 3 times per week. For example, a few people need 4 or more sessions per week to keep healthy, and some people are fine with only 2 sessions per week – this is usually people who are older, or those who have only just started dialysis. Special considerations for children and pregnant patients are also covered here.This section deals with membranes (the type of “filter” used in the dialysis machine) and “HDF” (haemodiafiltration) which is a more complex kind of dialysis which some doctors think is better. Studies are still being done, but at the moment we think it’s as good as but not better than regular dialysis.This section deals with fluid removal during dialysis sessions: how to remove enough fluid without causing cramps and low blood pressure. Amongst other recommendations we advise close collaboration with patients over this.This section deals with dialysate, which is the fluid used to “pull” toxins out of the blood (it is sometimes called the “bath”). The level of things like potassium in the dialysate is important, otherwise too much or too little may be removed. There is a section on dialysate buffer (bicarbonate) and also a section on phosphate, which occasional...

Ultrasound-guided Placement of Permanent Hemodialysis Catheters Compared to the Traditional Blind Method

“…Each insertion method could be selected as the first insertion method, depending on the practitioners' choice. According to the recommendations of international organizations, such as NICE2002 and Renal Association 2007 for using sonography-guided insertion as the first method, and by considering its advantages such as more patients' satisfaction, it appears that sonography-guided method should be chosen as the first insertion method [7,15].…”

Major Outcomes With Personalized Dialysate TEMPerature (MyTEMP): Rationale and Design of a Pragmatic, Registry-Based, Cluster Randomized Controlled Trial

“…Potential Techniques to Address Low Adherence at a Center Depending on the Allocated Group.Potential reason for low complianceHow the issue may be addressedControl armPatients are hypotensive and may require cooler dialysate temperature When patients are at high risk of intradialytic hypotension, and the treating physician wishes to lower the dialysate temperature, we ask their treating physician to consider lowering the dialysate temperature at increments of 0.5°C rather than prescribing a set temperature below 36°C. This recommendation aligns with guidelines from the Canadian Society of Nephrology and other organizations46,47 Nurses forget to use the prescribed dialysate protocol Nurse educator or charge nurse is asked to highlight the importance of following the prescribed dialysate temperature during their regular rounds and educational sessions. Specific nurses not following the prescribed dialysate temperature protocol are approached separately for retraining/educationIn centers when this occurs, we ask the lead site investigator to speak directly with those nurses regarding the potential impact of raising the dialysate temperature beyond the patient's body temperature.…”

Applications of Near Infrared Photoacoustic Spectroscopy for Analysis of Human Respiration: A Review

“…The dose of dialysis is prescribed on the basis of urea removal measures [161]. The treatment at patients undergoing haemodialysis (HD) is administered at least three times a week for 4-5 h, are people that need four or more sessions per week to keep healthy, and some people are fine with only two sessions per week-this is usually people who are older in order to ensure optimum toxin removal [162]. Toxins that are more relevant to HD are not used as biomarkers due to technical difficulties, although a rapid, low cost measurement method would be desirable.…”