Dry weight (normotension without the need for

Dry weight (normotension without the need for this website antihypertensive medications) is targeted in the same way for patients on SDHD and NHD as for those on conventional HD. However, patients are more likely to achieve their dry weight with more frequent HD regimens. Despite generally lower ultrafiltration rates and better volume control, patients at home can have a tendency to achieve excessive interdialytic weight gains given the increased flexibility of dialysis regimens and liberalization of diet and fluids. Patients on SDHD and NHD should still be encouraged to reduce fluid accumulation and limit gains <2 L

in between sessions. With improved volume control, blood pressure may drop over time in both SDHD and NHD requiring reduction or even discontinuation of antihypertensive medications.34 Generally, non-cardioprotective antihypertensive medications should be stopped first. As with conventional HD, good vascular access is crucial for successful dialysis with alternative HD regimens. Difficult HKI 272 access means difficult needling, longer training time and an unhappy patient. An arteriovenous fistula

(AVF) is the preferred vascular access for alternative HD regimens. NHD can be delivered successfully with an AVF using double-needle or even single-needle cannulation techniques; and patients at home are usually self-needling. Single-needle cannulation may potentially increase safety in case of accidental needle dislodgement and theoretically could increase access survival because of fewer cannulations. Although this technique Amylase reduces the dose of dialysis by decreasing effective dialysis time and potentially increasing the degree of access recirculation, this problem is less of a concern with

NHD. Central venous catheter (CVC) use at home is also possible but not encouraged. In the most recent IQDR, 63% of patients undertaking NHD at home in Australia and New Zealand were dialysing through a native AVF and 32% were dialysing though a CVC.6 These proportions are similar to those for the conventional HD population in both countries as well as for alternative HD patients in Canada undertaking NHD at home. In the Australian cohort alone however, the prevalence rates for CVC were between 0% and 9% according to the IQDR report in 2008, much better than the HD population in Australia as a whole.35 The reasons for the higher AVF rates in NHD patients at home in Australia are not known but may include patient characteristics that increase the likelihood of having an AVF created in the first place. There are several methods of AVF cannulation for alternative HD regimens. The ‘buttonhole technique’ involves creation of a subcutaneous tract (composed of scar tissue between the skin and the access) allowing for repeated cannulation at the same arterial and venous sites.

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