Hemodialýza - současná praxe
| Title in English | Haemodialysis – the current practice |
|---|---|
| Authors | |
| Year of publication | 2011 |
| Type | Article in Periodical |
| Magazine / Source | Vnitřní lékařství |
| MU Faculty or unit | |
| Citation | |
| Field | Other medical specializations |
| Keywords | haemodialysis; initiation of haemodialysis; haemodialysis main principle; venous access; anticoagulation treatment; haemodiafiltration; duration of haemodialysis; adequate haemodialysis; dry weight assessment |
| Description | 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 8-10mL/min, and to 15mL/min when the patiens have risk factors. Haemodalysis is usually performed 3 times a week for 4 hours; less frequent or shorter haemodialysis is acceptable only in patiens 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 patiens 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 36-35C 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 patiens. 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. |