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Daily hemodialysis: an update

Daily hemodialysis: an update
Andreas Pierratos
Curr Opin Nephrol Hypertens 11:165-171.
© 2002 Lippincott Williams & Wilkins

Safety

• No guidelines have been established for short daily hemodialysis. It is likely that a partner may not be needed for the majority of patients on short daily hemodialysis.
• A partner at home during nocturnal dialysis has not been required. Extra safety precautions are necessary for nocturnal hemodialysis. In order to prevent air embolism in the case of the accidental disconnection of the central venous catheter, the InterLink system (Becton Dickinson, Franklin lakes, New Jersey, USA) has been utilized.
• A plastic non-disposable clamshell locking-box around the catheter-tubing connection can prevent an accidental separation.
• Blood or dialysate leaks are sensed by moisture sensors placed strategically on the floor and an "enuresis" alarm is taped on both "arterial" and "venous" needles.

Monitoring

• Remote monitoring at this point is considered optional and its need has been debated.

Patient selection criteria

• The main selection criteria for training for home hemodialysis are the ability and willingness to learn and adequate space for the machine and supplies.
• A contraindication to heparin precludes the use of nocturnal hemodialysis but not of short daily hemodialysis.
• Serious comorbid conditions and hemodynamic instability have not been contraindications for daily hemodialysis, especially in the form of nocturnal hemodialysis. These have included terminal heart failure, intractable ascites or diabetes with inoperable coronary artery disease.
• Incident end-stage renal disease patients are excellent candidates for daily hemodialysis.

It is estimated that approximately 20% of the current dialysis population can be trained for home hemodialysis using the current machines.