ISSN: 1305-385X
Hakkında: Özel sayılar şeklinde yayınlanır.
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Prescription Of Hemodialysis
Dr. Metin SİNGAN,a Dr. Siren SEZERb
aNefroloji Bölümü, Başkent Üniversitesi Adana Uygulama ve Araştırma Hastanesi, ADANAbNefroloji BD, Başkent Üniversitesi Tıp Fakültesi, ANKARA
Hemodialysis (HD) is based on fluid-solute exchange between patient’s blood and appropriate dialysis solution through a semi-permeable membrane. Dialyser membranes are produced from cellulose derivatives like cuprophane, cellulose acetate and synthetic ploymers like polyacrylonitril and polysulphane. There are high-efficiency and high-flux types. Blood flow rate for dialysis of a normal adult is usually 200-600 ml/min. Two kinds of dialysis solutions exist; acetate and bicarbonate. Ions to be cleared from blood must be added in equal amounts as they are in patient’s serum. Sodium passes through dialysis membrane to dialysate via diffusion and convection. Studies comparing standard HD and sodium-profiled HD showed better cardiovascular stability. Dialysis solution usually has a flow rate of 500 ml/min. The spKt/V, firstly proposed by Gotch after the secondary analysis of NCDS data, is used to calculate dialysis dose. According NKF-DOQI guidelines, for adequate dialysis target for single-pool spKt/Vüre is 1.3, for double-pool eKt/Vüre is 1.05 and for urea reduction rate is 70%. During a dialysis session, ultrafiltration volume must not exceed 4 lts. For patients with determined dry weights, ideal interdialytic weight gain must be 2-3 kgs. Anticoagulation may be with heparin, low molecular weight heparin, flush with serum pyhsiologic, citrate, prostocycline, heparinoids, hirudoid and prosthesis inhibitors. Up to date, alternative regimens such as intermittant high-duration, daily low-duration and night dialyses have been employed. Practically, cost mostly determines dialysis duration. Therefore, as determined by Ministery of Health, dialysis is prescribed 3 sessions/week, not shorter than 4 hours/session and adequacy of dialysis is determined monthly.Keywords: Hemodialysis, prescription, adqeuacyTurkiye Klinikleri J Int Med Sci 2006, 2(4):6-12
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