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Hemodialysis in Clinical Practice

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Management of Kidney Diseases

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Abstract

The technology of Hemodialysis remains the cornerstone of kidney replacement therapy, and globally the most widely practiced modality in end stage kidney disease. An understanding of the core principles of the therapy, and its advances, is fundamental to ensuring safety, high standards of practice, and quality-assured treatment delivery.

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References

  1. Haroon S, Davenport A. Choosing a dialyzer: what clinicians need to know. Hemodial Int. 2018;22(S2):S65–74.

    Article  PubMed  Google Scholar 

  2. Khan MA, Hussain A. Hemodialysis membranes: a review. J Membr Sci Technol. 2019;9:199.

    Google Scholar 

  3. Eloot S, Schneditz D, Vanholder R. What can the dialysis physician learn from kinetic modelling beyond kt/v urea? Nephrol Dialysis Transpl. 2012;27(11):4021–9.

    Article  Google Scholar 

  4. Mitra S, Mitsides N. Technical aspects of hemodialysis. Core concepts in dialysis and continuous therapies; 2016, pp. 15–26.

    Google Scholar 

  5. Canaud B, Busink E, Apel C, Bowry SK. Is there not sufficient evidence to show that haemodiafiltration is superior to conventional haemodialysis in treating end-stage kidney disease patients? Blood Purif. 2018;46(1):7–11.

    Article  PubMed  Google Scholar 

  6. Cronin RE, Reilly RF. Unfractionated heparin for hemodialysis: still the best option. In: Seminars in dialysis, vol. 23. Oxford: Blackwell Publishing Ltd.; 2010. p. 510–5, No. 5.

    Google Scholar 

  7. Assimon MM, Flythe JE. Rapid ultrafiltration rates and outcomes among hemodialysis patients: re-examining the evidence base. Curr Opin Nephrol Hypertens. 2015;24(6):525–30.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Vanholder R. Single needle hemodialysis: is the past the future? J Nephrol. 2020;33(1):49–58.

    Article  CAS  PubMed  Google Scholar 

  9. Upadhyay A. Dialyzer reuse: is it safe and worth it? Brazil J Nephrol. 2019;41(3):312–4.

    Article  Google Scholar 

  10. Lowrie EG, Li Z, Ofsthun N, Lazarus JM. Reprocessing dialysers for multiple uses: recent analysis of death risks for patients. Nephrology Dialysis Transplantation. 2004;19(11):2823–30.

    Article  Google Scholar 

  11. Young BA, Chan C, Blagg C, Lockridge R, Golper T, Finkelstein F, et al. How to overcome barriers and establish a successful home HD program. Clin J Am Soc Nephrol. 2012;7(12):2023–32.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mitra S, Kharbanda K. Home haemodialysis and haemodiafiltration. IntechOpen; 2016.

    Book  Google Scholar 

  13. Himmelfarb J, Kliger AS. End-stage renal disease measures of quality. Annu Rev Med. 2007;58:387–99.

    Article  CAS  PubMed  Google Scholar 

  14. Blankschaen SM, Saha S, Wish JB. Management of the hemodialysis unit: core curriculum 2016. Am J Kidney Dis. 2016;68(2):316–27.

    Article  PubMed  Google Scholar 

  15. Garrick R, Kliger A, Stefanchik B. Patient and facility safety in hemodialysis: opportunities and strategies to develop a culture of safety. Clin J Am Soc Nephrol. 2012;7(4):680–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Burlacu A, Iftene A, Jugrin D, Popa IV, Lupu PM, Vlad C, Covic A. Using artificial intelligence resources in dialysis and kidney transplant patients: a literature review. BioMed Res Int. 2020, 2020;

    Google Scholar 

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Author information

Authors and Affiliations

  1. Manchester University Hospitals NHS Foundation Trust, Manchester, UK

    Mohamed Elewa

  2. Ain Shams University, Cairo, Egypt

    Mohamed Elewa

  3. Manchester University Hospitals NHS Foundation Trust, Manchester, UK

    Sandip Mitra

  4. Manchester Academy of Health Sciences Centre, University of Manchester, Manchester, UK

    Sandip Mitra

Authors
  1. Mohamed Elewa
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  2. Sandip Mitra
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Corresponding author

Correspondence to Sandip Mitra .

Editor information

Editors and Affiliations

  1. St George’s University Hospitals NHS Foundation Trust and St George’s, University of London, London, UK

    Debasish Banerjee

  2. The George Institute for Global Health, New Delhi, India

    Vivekanand Jha

  3. St George’s University Hospitals NHS Foundation Trust and St George’s, University of London, London, UK

    Nicholas M.P. Annear

Questions

Questions

  1. 1.

    The single most effective means of increasing diffusive clearance of small solutes during HD such as in Predialysis Hyperkalemia is:

    1. A.

      Increasing Dialysate flow rate

    2. B.

      Increase Dialyser Size

    3. C.

      Administer Insulin dextrose

    4. D.

      Increasing haemodialysis machine blood flow rate

    5. E.

      Increasing Time on dialysis

    Correct answer (D)

  2. 2.

    The signs that indicate excessive clotting in circuit during treatment are:

    1. A.

      Raised venous pressure

    2. B.

      Reduced arterial pressure

    3. C.

      Raised trans membrane pressure (TMP)

    4. D.

      Visible signs of clotting, streaky dialyser

    5. E.

      Low dialysate conductivity

    Correct answer (A, B, C, D)

  3. 3.

    Indicate which of these factors will not trigger alarms for High venous pressures

    1. A.

      Blood Circuit connection error

    2. B.

      AVF stenosis

    3. C.

      Kink in the blood tubing, returning limb

    4. D.

      Kink in blood tubing pre dialyser

    5. E.

      Occluded venous limb of dialysis catheter

    Correct answer (A, D)

  4. 4.

    Disconnection haemorrhage from a catheter can be prevented by

    1. A.

      Keeping access site visible at all time during a treatment

    2. B.

      Adherence to a Safe Taping policy

    3. C.

      Optimum securement of the lines

    4. D.

      A robust HD governance structure

    5. E.

      Specific modules incorporated in staff competency training and assessment

    Correct answer (A, B, C, D, E)

  5. 5.

    Which of these constitute good practice in Ultrafiltration?

    1. A.

      Limit Interdialytic weight gain to 3% body weight

    2. B.

      UF rate should vary between 10–20 mL/kg/h

    3. C.

      Empower patients with knowledge on fluid balance

    4. D.

      Reassess target weight on a monthly basis

    5. E.

      Use relative blood volume monitoring for unstable patients

    6. F.

      Use Iso UF regularly for fluid overload

    Correct answer (A, C, D, E)

  6. 6.

    The following are some clinical features of middle molecule toxicity

    (Residual syndrome)

    1. A.

      Macroglossia

    2. B.

      Arthropathy

    3. C.

      Haemochromatosis

    4. D.

      Carpal Tunnel syndrome

    5. E.

      Neuropathy

    Correct answer (A, B, D, E)

  7. 7.

    Convective clearances can be augmented in Haemodiafiltration by the following

    1. A.

      Switch from 15 g to 16 g needles for cannulation

    2. B.

      Use of higher surface area dialysers

    3. C.

      Adequate Anticoagulation

    4. D.

      Higher blood pump speeds

    5. E.

      Increased treatment time

    Correct answer (B, C, D, E)

  8. 8.

    Expanded HD therapy delivers improved dialytic toxin clearances on middle and large middle molecules through the use of:

    1. A.

      Large surface area dialysers

    2. B.

      High pore density dialyser

    3. C.

      Homogenous dialyser pore size distribution

    4. D.

      Substitution fluid and additional pump

    5. E.

      HD machine special design and adaptation

    Correct answer (B, C)

  9. 9.

    Advantages of Button-hole cannulation strategy for AVF include

    1. A.

      needling short AVF segments

    2. B.

      lower risk of infections

    3. C.

      addressing needle phobia

    4. D.

      requires skilled expertise and resiting

    5. E.

      use of sharp needles in a preformed track to alleviate pain

    Correct answer (A, C)

  10. 10.

    The key clinical indications for recommending extended HD at Home are

    1. A.

      Persistent fluid overload and hypertension

    2. B.

      High interdialytic weight gain and ultrafiltration rate

    3. C.

      Dialysis via Catheter

    4. D.

      Uncontrolled anemia

    5. E.

      Severe LVH (increased LV mass)

    Correct answer (A, B, E)

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Elewa, M., Mitra, S. (2023). Hemodialysis in Clinical Practice. In: Banerjee, D., Jha, V., Annear, N.M. (eds) Management of Kidney Diseases. Springer, Cham. https://doi.org/10.1007/978-3-031-09131-5_17

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  • DOI: https://doi.org/10.1007/978-3-031-09131-5_17

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-09130-8

  • Online ISBN: 978-3-031-09131-5

  • eBook Packages: MedicineMedicine (R0)

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