Hemodialysis orders part 1

Hemodialysis prescription,
Targeting a friendly dialysis
Part I
Jafar Alsaid M.B.CHB.MD.FASN.FACP
Assistance Professor, Ochsner Clinical School/University of Queensland ( Australia)
Nephrology Consultant. Ochsner Health system.
1
8/13/2021 JAFAR ALSAID, MB.ChB. MD. FASN. FACP. AUG. 2021

Hemodialysis Prescription,
Part I
• Introduction.
• Historic points
• Statistics. USRDS 2020.
• How to break the news to the
patient.
• Variables in decision for Dialysis.
• Hemodialysis Targets.
• Hemodialysis Complications
2
Part II
Choosing a Filter.
QB/QD.
Dialysis adequacy.
Anticoagulation in hemodialysis.
Part III
Hemodynamics and BP.
Ultrafiltration.
Temp.
Dialysate Na.
Dialysate Ca.
Online Volume Control
mode.
Research aspects.

Hemodialysis prescription,
Part I
3

History of the kidney disease treatment (sgkpa.org.uk);
The first human dialysis machine
Dr. Willem Kolff (1911-2009) is considered by most to be the father of dialysis. This
young Dutch physician constructed the first dialyzer (artificial kidney) in 1943.
4

CIN2003. Shaldon. PERSONAL HISTORY OF VASCULAR ACCESS (uninet.edu)
5

Incidence
6

Prevalence
7

113000
14000
3850
443
8

485000
230000
59000
10000
9

303
257
111
10

161
132
49
13

14

42
40
35
15

84
83
82
16

17

18

You will need to start
dialysis
Access, nursing, on call, machine,
lunch time, leaving to home. End of life, Family, financial, work,
complication, pain, is it worth?
19

Hemodialysis
Why?
When?
Which?
How?
What?
20

Quality of life
21

Quality of life
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backwards-AND-blindfolded.html 23

Can we make a difference?
24

CONCLUSION
• ESRD incidence started to decreased since 2008 in US, but it had plateaued over a decade.
• ESRD prevalence is still increasing in US.
• The main increase is among ESRD receiving incenter HD.
• The minimum number is among patients receiving home hemodialysis.
• Although the annual mortality among ESRD patient is US is decreasing. It is still three times
more than any other medical disease including CVD and Cancer.
• The transplant mortality matched the other medical disease mortality in US, at one third
lower than Hemodialysis and PD mortality.
• The highest incidence of Mortality is within the first 3 months of initiation of dialysis.
• The probability of survival in US ESRD with Cadaveric Transplant is double that of Dialysis
patients.
• CV disease is the first cause of death among ESRD and Infection is the second cause.
• Quality of life should be one of the main variables taken in consideration upon initiation renal
replacement therapy.
• a balance between
8/13/2021 JAFAR ALSAID, MB.ChB. MD. FASN. FACP. AUG. 2021 25

Hemodialysis orders part 1

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