{"id":177,"date":"2013-10-25T06:20:07","date_gmt":"2013-10-25T00:50:07","guid":{"rendered":"http:\/\/wp.kidneyadvice.net\/wordpress\/?page_id=177"},"modified":"2020-01-23T08:09:00","modified_gmt":"2020-01-23T02:39:00","slug":"adequacy-of-hd","status":"publish","type":"page","link":"https:\/\/wp.kidneyadvice.net\/wordpress\/?page_id=177","title":{"rendered":"Adequacy of HD"},"content":{"rendered":"<p>Previous:<a title=\"Requirements\" href=\"http:\/\/wp.kidneyadvice.net\/wordpress\/?page_id=169\">Dialyzer and Hemodialysis Machine<\/a><\/p>\n<h2>How frequently should Hemodialysis be done?<\/h2>\n<p align=\"justify\">The minimum that is advisable is <em>three times a week<\/em>, each session being four hours long.<\/p>\n<p align=\"justify\">When dialysis is done in this fashion, only approximately 10% of kidney functions are replaced ! This amount of dialysis is barely enough to maintain patients symptom-free and away from major problems.<\/p>\n<p align=\"justify\">Even better results can be obtained when dialysis is done more frequently and\/or longer; e.g. 6 to 8 hrs at night every night. The survival and quality of life in these patients is far better than in those who take dialysis three times a week.<\/p>\n<p align=\"justify\">In contrast, people who take dialysis two times a week or less, have poor long term survival, poor quality of life and significantly higher rates of hospitalization for life threatening problems.<\/p>\n<h2>What is an adequate Hemodialysis?<\/h2>\n<p>Clinical signs of adequate dialysis include:<\/p>\n<ul>\n<li>Feeling of well-being<\/li>\n<li>Good appetite, good sleep<\/li>\n<li>Improved efficiency through the day<\/li>\n<li>Good BP control<\/li>\n<li>Steady dry-weight (see below) or Increase in dry weight without edema<\/li>\n<\/ul>\n<h2>Dry Weight<\/h2>\n<p align=\"justify\">This is the lowest body weight at which patient is free of swelling on the feet and has no episodes of low blood pressure or cramps on dialysis.<\/p>\n<p align=\"justify\">Weight is recorded before and after each dialysis session. During dialysis, excess water is removed and therefore patient loses weight at the end of dialysis session.<\/p>\n<p align=\"justify\">Before the next HD, patient gains weight because he has a certain amount of fluid intake daily. There will obviously be no weight gain if patient passes normal amount of urine daily. This situation is extremely rare in maintenance hemodialysis patients.<\/p>\n<h2 align=\"justify\">How does one measure dialysis adequacy?<\/h2>\n<p align=\"justify\">There are several ways of doing it. One way is to look for clinical signs as listed above. If all of them are present, the patient is dialyzed adequately.<\/p>\n<p align=\"justify\">One can objectively measure dialysis adequacy and this is routinely done at good dialysis centres.<\/p>\n<p align=\"justify\">Commonest method is to measure blood Urea level before dialysis and then immediately at the end of that dialysis session. The post-dialysis value should come down by more than 65% of the pre-dialysis value. This is called Urea Reduction Ratio (URR).<\/p>\n<p align=\"justify\">E.g. If pre-dialysis Urea is 100 and the post dialysis value is 30, the reduction in urea is by 70%, which means, that particular dialysis session was adequate.<\/p>\n<p align=\"justify\">Survival is much longer in patients who are dialyzed adequately i.e. at least three times a week with a URR of 65% each time.<\/p>\n<h2 align=\"justify\">If dialysis is inadequate, how can one improve on it?<\/h2>\n<p align=\"justify\">If the URR is less than 65%, there are several ways by which this can be improved upon.<\/p>\n<ul>\n<li>Increase the blood flow.\n<ul>\n<li>This will effectively treat more amount of blood in the same time and therefore, clearance will improve.<\/li>\n<\/ul>\n<\/li>\n<li>Increase the dialysate flow.\n<ul>\n<li>This will clean the blood more effectively at the same blood flows.<\/li>\n<\/ul>\n<\/li>\n<li>Use a bigger dialyzer.\n<ul>\n<li>This will provide larger surface area for the exchange process and increase overall efficiency of dialysis.<\/li>\n<\/ul>\n<\/li>\n<li>Increase dialysis frequency.<\/li>\n<li>Increase duration of dialysis.<\/li>\n<\/ul>\n<h2 align=\"justify\">What are the complications of Hemodialysis?<\/h2>\n<p align=\"justify\">Hemodialysis is a very safe therapy. The only common complications are episodes of low blood pressures and cramps. These occur when excess fluid is removed in short span of time.<\/p>\n<p align=\"justify\">This is one reason why, between two dialysis sessions, the weight gain should not be high.<\/p>\n<h2 align=\"justify\">Does frequency of hemodialysis reduce with time?<\/h2>\n<p align=\"justify\">This is a commonly asked question. If you have understood the &#8216;adequacy of hemodialysis&#8217; section, you already have the answer to that question. No.<\/p>\n<p style=\"text-align: left;\" align=\"right\">The only way to stop dialysis is to get a kidney transplantation done.<\/p>\n<p align=\"right\">\n<p align=\"right\">Next: <a title=\"Peritoneal Dialysis\" href=\"http:\/\/wp.kidneyadvice.net\/wordpress\/?page_id=185\">Peritoneal Dialysis<\/a><\/p>\n<div id=\"bodybottom\"><\/div>\n<!-- Anyway Feedback Container \/\/-->\n<div class=\"afb_container\" id=\"afb_comment_container_177\"><span class=\"message\">Is this Page useful?<\/span>\r\n<a class=\"good\" href=\"https:\/\/wp.kidneyadvice.net\/wordpress\/wp-admin\/admin-ajax.php\">Useful<\/a>\r\n<a class=\"bad\" href=\"https:\/\/wp.kidneyadvice.net\/wordpress\/wp-admin\/admin-ajax.php\">Not Useful<\/a>\r\n<span class=\"status\">0 of 0 people say this Page is useful.<\/span><input type=\"hidden\" name=\"post_type\" value=\"page\" \/>\n<input type=\"hidden\" name=\"object_id\" value=\"177\" \/>\n<\/div>\n<!-- \/\/Anyway Feedback Container -->","protected":false},"excerpt":{"rendered":"<p>Previous:Dialyzer and Hemodialysis Machine How frequently should Hemodialysis be done? The minimum that is advisable is three times a week, each session being four hours long. When dialysis is done in this fashion, only approximately 10% of kidney functions are replaced ! This amount of dialysis is barely enough to maintain patients symptom-free and away &#8230;<\/p>\n<p><a href=\"https:\/\/wp.kidneyadvice.net\/wordpress\/?page_id=177\" class=\"more-link\">Continue reading &lsquo;Adequacy of HD&rsquo; &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/wp.kidneyadvice.net\/wordpress\/index.php?rest_route=\/wp\/v2\/pages\/177"}],"collection":[{"href":"https:\/\/wp.kidneyadvice.net\/wordpress\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/wp.kidneyadvice.net\/wordpress\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/wp.kidneyadvice.net\/wordpress\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wp.kidneyadvice.net\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=177"}],"version-history":[{"count":6,"href":"https:\/\/wp.kidneyadvice.net\/wordpress\/index.php?rest_route=\/wp\/v2\/pages\/177\/revisions"}],"predecessor-version":[{"id":809,"href":"https:\/\/wp.kidneyadvice.net\/wordpress\/index.php?rest_route=\/wp\/v2\/pages\/177\/revisions\/809"}],"wp:attachment":[{"href":"https:\/\/wp.kidneyadvice.net\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=177"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}