Haemodialysis – the current practice

Česká verzia

Authors: M. Nedbálková
Authors place of work: II. interní klinika Lékařské fakulty MU a FN u sv. Anny v Brně, přednosta prof. Miroslav Souček, CSc.
Published in the journal: Vnitř Lék 2011; 57(7&8): 640-644
Category: 136th internal medicine day, XXIV. Vanýskův den, Brno 2011

Summary

New techniques and technological innovations developed over the last decades have facilitated improvements in haemodialysis. An emphasis is on an early insertion of arteriovenous fistula as a venous access for haemodialysis. Dialysis treatment should be initiated when the glomerular filtration rate falls to 8–10 mL/min, and to15 mL/min when the patients have risk factors. Haemodialysis is usually performed 3 times a week for 4 hours; less frequent or shorter haemodialysis is acceptable only in patients with well-preserved residual renal function. Extending haemodialysis to 5–6 hours is useful in preventing complications. Haemodiafiltration with high flux membranes, more permeable for middle molecules, is preferred in patients with long-term haemodialysis. Correct assessment of dry weight, i.e. an optimal body weight after haemodialysis without any signs of hypervolaemia, is important. Apart from a clinical assessment, body composition monitor (BCM) that uses bioimpedance to assess the proportion of water in the body, is helpful in determining dry weight. Reduction of dialysis solution temperature to 36–35 °C and blood volume monitor (BVM) that measures changes in haematocrit during water elimination, are used to prevent dialysis-associated hypotension. Potassium profiling decreases the incidence of arrhythmias in haemodialysed cardiac patients. Blood temperature monitor (BTM) is used to measure recirculation and thus to detect an arteriovenous fistula dysfunction. Protection of residual renal function through an elimination of nephrotoxic substances as well as prevention of hypotension and excessive ultrafiltrations is an important part of care for a haemodialysed patient.

Key words:
haemodialysis – initiation of haemodialysis – haemodialysis main principle – venous access – anticoagulation treatment – haemodiafiltration – duration of haemodialysis – adequate haemodialysis – dry weight assessment

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