{"id":2754,"date":"2020-03-18T16:46:57","date_gmt":"2020-03-18T21:46:57","guid":{"rendered":"https:\/\/ami.advancedrenaleducation.com\/wparep\/?post_type=article&p=941"},"modified":"2025-05-09T14:39:16","modified_gmt":"2025-05-09T19:39:16","slug":"hemodialysis-regimens-prescriptions","status":"publish","type":"article","link":"https:\/\/ami.advancedrenaleducation.com\/wparep\/asiapacific\/article\/hemodialysis-regimens-prescriptions\/","title":{"rendered":"Hemodialysis Regimens and Prescriptions"},"content":{"rendered":"

The proliferation of <\/span><\/span>hemodialysis (<\/span><\/span>HD<\/span><\/span>)<\/span><\/span>\u00a0regimens\u00a0<\/span><\/span>may be confusing to many; as such, this article aims to provide a summary of the accepted HD definitions<\/span><\/span>.<\/span><\/span>\u00a0<\/span><\/span>Conventional<\/span><\/span>\u00a0<\/span><\/span>HD<\/span><\/span>\u00a0<\/span><\/span>is the m<\/span><\/span>ost common treatment for ESRD worldwide and is usually performed 3-5 hours, 3 days per week (<\/span><\/span>1\u20134)<\/span><\/span><\/span>.<\/span><\/span>\u00a0<\/span><\/span>Over past\u00a0<\/span><\/span>few\u00a0<\/span><\/span>decades, m<\/span><\/span>ore frequent dialysis than the standard three-times-a week<\/span><\/span>\u00a0dialysis has<\/span><\/span>\u00a0been performed<\/span><\/span>.<\/span><\/span>\u00a0Various terms\u00a0<\/span><\/span>(e.g., daily, nocturnal, short daily, daily nocturnal, quotidian, frequent, and intensiv<\/span><\/span>e)\u00a0<\/span><\/span>HD<\/span><\/span> have been used to characterize either longer duration, increased frequency or both (<\/span><\/span>5)<\/span><\/span><\/span>.\u00a0<\/span><\/span>However, a standard nomenclature describing the HD prescriptions is lacking<\/span><\/span>.<\/span><\/span>\u00a0<\/span><\/span>Kidney Disease: Improving Global Outcomes<\/span><\/span>\u00a0(<\/span><\/span>KDIGO<\/span><\/span>)<\/span><\/span>\u00a0<\/span><\/span>work\u00a0<\/span><\/span>group\u00a0<\/span><\/span>has proposed the following nomenclature to describe the different prescription as described in the Table 1 (<\/span><\/span>5)<\/span><\/span><\/span>. Similarly, based on suggestion from KDIGO,\u00a0<\/span><\/span>t<\/span><\/span>he National Kidney Foundation\u2019s Kidney Disease Outcomes Quality Initiative (KDOQI)\u00a0<\/span><\/span>suggest that all HD prescriptions need to\u00a0<\/span><\/span>specify<\/span><\/span>\u00a0<\/span><\/span>\u201c<\/span><\/span>duration of the individual dialysis session, the number of treatments per week, blood and\u00a0<\/span><\/span>dialysate flow rates, the location for HD treatment, and the level of assistance<\/span><\/span>\u201d; the proposed nomenclature is described in Table 2 (<\/span><\/span>6)<\/span><\/span><\/span>.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n

Table 1: Descriptive nomenclature for hemodialysis frequency and duration (<\/span><\/span>5)<\/span><\/span><\/span>\u00a0<\/span><\/p>\n\n\n\n\n\n\n
Conventional hemodialysis<\/strong>\u00a0<\/span><\/td>\n3\u20135\u202fh per session, three times per week<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
Short daily hemodialysis\u00a0<\/strong><\/td>\nLess than 3\u202fh per session, six times per week<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
Standard daily hemodialysis\u00a0<\/strong><\/td>\n3\u20135\u202fh per session, six times per week<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
Long daily hemodialysis\u00a0<\/strong><\/td>\nMore than 5\u202fh per session, six times per week<\/span>\u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Table 2: Descriptive nomenclature of various HD prescriptions<\/span><\/span> (<\/span><\/span>6)<\/span><\/span><\/span>\u00a0<\/span>\u00a0<\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Proposed name\u00a0<\/strong><\/td>\nTime of day\u00a0<\/strong><\/td>\nFrequency\u00a0(Sessions\/wk.)\u00a0<\/strong><\/td>\nDuration\u00a0(h\/session)\u00a0<\/strong><\/td>\n<\/tr>\n
Conventional HD<\/span>\u00a0<\/span><\/td>\nDaytime<\/span>\u00a0<\/span><\/td>\n3-4<\/span>\u00a0<\/span><\/td>\n3-5<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
Frequent\u00a0HDa\u00a0<\/sup><\/strong><\/td>\n\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\n<\/tr>\n
Short<\/span>\u00a0<\/span><\/td>\nDaytime<\/span>\u00a0<\/span><\/td>\n5-7<\/span>\u00a0<\/span><\/td>\n<3<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
Standard<\/span>\u00a0<\/span><\/td>\nDaytime<\/span>\u00a0<\/span><\/td>\n5-7<\/span>\u00a0<\/span><\/td>\n3-5<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
Long<\/span>\u00a0<\/span><\/td>\nNighttime<\/span>\u00a0<\/span><\/td>\n5-7<\/span>\u00a0<\/span><\/td>\n>5<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
Long\u00a0HDb\u00a0<\/sup><\/strong><\/td>\n\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\n<\/tr>\n
Long thrice weekly\u00a0<\/span>\u00a0<\/span><\/td>\nNighttime or daytime<\/span>\u00a0<\/span><\/td>\n3<\/span>\u00a0<\/span><\/td>\n>5<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
Long every other night<\/span>\u00a0<\/span><\/td>\nNighttime<\/span>\u00a0<\/span><\/td>\n3.5<\/span>\u00a0<\/span><\/td>\n>5<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
Long frequent<\/span>\u00a0<\/span><\/td>\nNighttime<\/span>\u00a0<\/span><\/td>\n5-7<\/span>\u00a0<\/span><\/td>\n>5<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
\n

Treatment Location\u00a0<\/strong><\/p>\n<\/td>\n<\/tr>\n

In-center<\/span>\u00a0<\/span><\/td>\nOutpatient treatment in a hospital or dialysis facility<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
Home<\/span>\u00a0<\/span><\/td>\nHD treatment in patient\u2019s home<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
\n

Blood\u00a0flow rate\u00a0<\/strong><\/p>\n<\/td>\n<\/tr>\n

Standard<\/span>\u00a0<\/span><\/td>\n\u2265300 mL\/min<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
Low flow<\/span>\u00a0<\/span><\/td>\n<300 mL\/min<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
\n

Dialysate flow rate\u00a0<\/strong><\/p>\n<\/td>\n<\/tr>\n

Standard<\/span>\u00a0<\/span><\/td>\n\u2265500 mL\/min<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
Low flow<\/span>\u00a0<\/span><\/td>\n<500 mL\/min<\/span>\u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

a: Short and standard daily HD are usually delivered in-center, while long-nocturnal HD is usually delivered at home.<\/span>\u00a0<\/span><\/p>\n

b: Long\u2212thrice weekly HD may be delivered in-center or at home, while long every other night and frequent HD are usually delivered at home.<\/span>\u00a0<\/span><\/p>\n

<\/div>\n

References:\u00a0<\/strong><\/p>\n

    \n
  1. Saran R, Robinson B, Abbott KC, Bragg-Gresham J, Chen X, Gipson D, Gu H, Hirth RA, Hutton D, Jin Y, Kapke A, Kurtz V, Li Y, McCullough K, Modi Z, Morgenstern H, Mukhopadhyay P, Pearson J, Pisoni R, et al. US Renal Data System 2019 Annual Data Report: Epidemiology of Kidney Disease in the United States.<\/span>Am J Kidney Dis<\/span><\/i>. 2020;75(1, Supplement 1):A6-A7.<\/span>\u00a0<\/span><\/li>\n
  2. Wile C. Kidney disease in Canada: highlights from the Canadian Institute for Health\u00a0 Information Annual Report.<\/span>CANNT J<\/span><\/i>. 2012;22(2):12. www.ncbi.nlm.nih.gov\/pubmed\/22913045<\/span>\u00a0<\/span><\/li>\n
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  4. Gray NA, Dent H, McDonald SP. Renal replacement therapy in rural and urban Australia.<\/span>Nephrol Dial Transplant\u00a0 Off Publ Eur\u00a0 Dial Transpl Assoc – Eur Ren Assoc<\/span><\/i>. 2012;27(5):2069-2076. www.ncbi.nlm.nih.gov\/pubmed\/21984553<\/span>\u00a0<\/span><\/li>\n
  5. Chan CT, Covic A, Craig JC, Davenport A, Kasiske BL, Kuhlmann MK, Levin NW, Li PKT, Locatelli F, Rocco M V, Wheeler DC. Novel techniques and innovation in blood purification: a clinical update from Kidney\u00a0 Disease: Improving Global Outcomes.<\/span>Kidney Int<\/span><\/i>. 2013;83(3):359-371. www.ncbi.nlm.nih.gov\/pubmed\/23325091<\/span>\u00a0<\/span><\/li>\n
  6. Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco M V., Suri RS, Weiner DE, Greer N, Ishani A, MacDonald R, Olson C, Rutks I, Slinin Y, Wilt TJ, Rocco M, Kramer H, Choi MJ, Samaniego-Picota M, Scheel PJ, et al. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update.<\/span>Am J Kidney Dis<\/span><\/i>. 2015;66(5):884-930.<\/span>\u00a0<\/span><\/li>\n<\/ol>\n

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