Dialysis Prescription: A Modifiable Risk Factor for Chronic Kidney Disease Patients

Abstract

Recent surveys of hemodialysis studies strongly support the fact that dialysis prescription is a modifiable risk factor. Six tracks to improve dialysis patient outcomes have been identified: change in vascular access option strategy and restricting catheter use; increasing time or frequency of dialysis sessions; assessment and management of fluid status; favoring removal of middle and large molecules by high-flux and convective clearance; considering ultrapurity of dialysis fluid purity as a new standard and a part of hemodialysis biocompatibility, and improving quality care and patient follow-up. By modifying dialysis prescription and by implementing a continuous quality assurance program it appears possible to improve dialysis patient survival.

Importance of normohydration for the long-term survival of haemodialysis patients

“…The efficient correction of the extracellular fluid overload with the goal of improving the high burden of cardiovascular mortality among dialysis patients remains one of the key challenges for nephrologists in the coming years [33]. Hyperhydration is a modifiable risk factor [34], it can be assessed objectively [14] and corrected without the occurrence of additional intradialytic adverse events [15]. Objective and quantitative assessment of the hydration status and combining this information with important clinical information (e.g.…”

Clinical evaluation of polyethersulfone high‐flux hemodialysis membrane compared to other membranes

“…Another important characteristic of high‐flux dialysis is that the higher blood and dialysate flows are used, and significant improvements in dialysis efficiency can be obtained. Since high‐flux dialysis (also called high‐efficiency dialysis in some times) is so much more efficient, it can allow significant reduction of dialysis times, often by 25% 5. Thus, the patient can receive adequate dialysis and meanwhile minimize the discomfort of long dialysis time.…”

“…Since high-flux dialysis (also called high-efficiency dialysis in some times) is so much more efficient, it can allow significant reduction of dialysis times, often by 25%. 5 Thus, the patient can receive adequate dialysis and meanwhile minimize the discomfort of long dialysis time. Another characteristic of high-flux dialysis is that the membranes used are more biocompatible, and therefore are less likely to stimulate the autoimmune system, which minimizes the allergic symptoms as well as the changes in white blood cell counts that were previously caused by less biocompatible membranes.…”

Implementation and Management of Strategies to Set and to Achieve Clinical Targets

“…Dialysis prescription and adjunctive medical treatment are intended to provide over time (from years to decades) an adequate and regular correction of metabolic disorders to each patient, to prevent side-effects and 'un-physiology' of intermittent dialysis and to preserve quality of life at an affordable cost. Treatment adequacy is then closely tied to the quality assurance process that links prescription and treatment delivery [7]. On one hand, prescription of the haemodialysis treatment relies mainly on the patient's metabolic needs, cardiovascular and general tolerance of sessions, dietary compliance, residual renal function [8] and local health care and economic offer.…”