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What Do I want ???What Do I want ???
Sudhakar Venturi
ST4
Sudhakar Venturi
ST4
HistoryHistory
Dialysis – 1861 Thomas Graham, Professor of Chemistry at
Anderson's University in Glasgow He noticed that crystalloids were able to diffuse
through vegetable parchment coated with albumin (which acted as a semi-permeable membrane).
Using this method he was able to extract urea from urine
Dialysis – 1861 Thomas Graham, Professor of Chemistry at
Anderson's University in Glasgow He noticed that crystalloids were able to diffuse
through vegetable parchment coated with albumin (which acted as a semi-permeable membrane).
Using this method he was able to extract urea from urine
George Haas (Germany) First successful human dialysis - 1924.
The dialysis lasted for 15 minutes with out any complications.
WJ Kolff and H Berk (Netherlands) 1943 - The first practical human haemodialysis
machine.
George Haas (Germany) First successful human dialysis - 1924.
The dialysis lasted for 15 minutes with out any complications.
WJ Kolff and H Berk (Netherlands) 1943 - The first practical human haemodialysis
machine.
One of Kolff's first artificial kidneys1946-1950
One of Kolff's first artificial kidneys1946-1950
Haemodialysis in the U KHaemodialysis in the U K 1948 - Bywaters and Joekes - published a
report on 12 patients treated with the artificial kidney at Hammersmith.
Dialysis for chronic renal failure Quinton and Scribner (1960) – arteriovenous
shunt was the key development.
1948 - Bywaters and Joekes - published a report on 12 patients treated with the artificial kidney at Hammersmith.
Dialysis for chronic renal failure Quinton and Scribner (1960) – arteriovenous
shunt was the key development.
1967 - The only renal unit in Wales, at Cardiff Royal Infirmary
1967 - The only renal unit in Wales, at Cardiff Royal Infirmary
Renal Replacement TherapyRenal Replacement Therapy Haemodialysis
Institutional Home
Conventional / Long duration Nocturnal
Peritoneal Dialysis CAPD APD
Transplantation Live DBD/DCD
Haemodialysis Institutional Home
Conventional / Long duration Nocturnal
Peritoneal Dialysis CAPD APD
Transplantation Live DBD/DCD
Nocturnal homeHaemodialysis Nocturnal homeHaemodialysis
Three to seven times per week at night during sleep, for six to ten hours More total time dialyzing shorter periods between treatments fluid removal speeds can be lower and gradual.
Three to seven times per week at night during sleep, for six to ten hours More total time dialyzing shorter periods between treatments fluid removal speeds can be lower and gradual.
Advantages of nocturnal home HDAdvantages of nocturnal home HD Better blood pressure management
less need for BP medication.
Avoidance of intradialytic hypotension. "Nocturnal hemodialysis increases arterial baroreflex sensitivity
and compliance and normalizes blood pressure of hypertensive
patients with end-stage renal disease". Kidney Int. (2005).
Better blood pressure management less need for BP medication.
Avoidance of intradialytic hypotension. "Nocturnal hemodialysis increases arterial baroreflex sensitivity
and compliance and normalizes blood pressure of hypertensive
patients with end-stage renal disease". Kidney Int. (2005).
More energy and less 'wash-out' after treatment
Less dietary restrictions - Phosphate binders, food restrictions.
More energy and less 'wash-out' after treatment
Less dietary restrictions - Phosphate binders, food restrictions.
Cardiovascular disease in ESRD patients is the leading cause of mortality. Nocturnal hemodialysis is proven to improve
Ejection Fraction, lead to a regression in left ventricular hypertrophy
"Effect of Frequent Nocturnal Hemodialysis vs Conventional Hemodialysis on Left Ventricular Mass and Quality of Life". Journal of the American Medical Association (2007)
"Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis". Kidney Int.
Cardiovascular disease in ESRD patients is the leading cause of mortality. Nocturnal hemodialysis is proven to improve
Ejection Fraction, lead to a regression in left ventricular hypertrophy
"Effect of Frequent Nocturnal Hemodialysis vs Conventional Hemodialysis on Left Ventricular Mass and Quality of Life". Journal of the American Medical Association (2007)
"Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis". Kidney Int.
Less expensive overall for the health system due to lower rates of hospitalization
"Reduction in cardiovascular related hospitalization with
nocturnal home hemodialysis". Clin. Nephrol. (2008).
More control over the dialysis treatment schedules - Greater life satisfaction
My Journey to Nocturnal Dialysis Marion Higgins
Less expensive overall for the health system due to lower rates of hospitalization
"Reduction in cardiovascular related hospitalization with
nocturnal home hemodialysis". Clin. Nephrol. (2008).
More control over the dialysis treatment schedules - Greater life satisfaction
My Journey to Nocturnal Dialysis Marion Higgins
Survival among NHHD patients compared to kidney
transplant recipients, Robert P. Pauly and others Nephrology Dialysis and Transplantation, May 2009
Survival among NHHD patients compared to kidney
transplant recipients, Robert P. Pauly and others Nephrology Dialysis and Transplantation, May 2009
Disadvantages of nocturnal home hemodialysis
Disadvantages of nocturnal home hemodialysis
Cost and effort Longer duration of training Home circumstances Night sleep
Machine alarms. (Experience from Lynchburg suggests it happens once every 10 days for people using a fistula and 1-2
times per night if using a catheter) NHHD - caregiver burden, depression, quality of life –
Hemodialysis International (FEB 2012)
Cost and effort Longer duration of training Home circumstances Night sleep
Machine alarms. (Experience from Lynchburg suggests it happens once every 10 days for people using a fistula and 1-2
times per night if using a catheter) NHHD - caregiver burden, depression, quality of life –
Hemodialysis International (FEB 2012)
In WalesIn Wales
UHW – None Swansea – 3 + 1 Bangor – None Glan Clwyd – None Wrexham - ?1
UHW – None Swansea – 3 + 1 Bangor – None Glan Clwyd – None Wrexham - ?1
What Do I wantWhat Do I want
Live related transplant – Identical twin Live related transplant DBD preferred than DCD Dialysis Peritoneal Dialysis
Prefer APD with day dwells
Haemodialysis
NHHD
Live related transplant – Identical twin Live related transplant DBD preferred than DCD Dialysis Peritoneal Dialysis
Prefer APD with day dwells
Haemodialysis
NHHD
Thank You Thank You