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BMC Nephrology
Published in: BMC Nephrology 1/2019

Open Access 01-12-2019 | Guidelines

Renal Association Clinical Practice Guideline on Haemodialysis

Authors: Damien Ashby, Natalie Borman, James Burton, Richard Corbett, Andrew Davenport, Ken Farrington, Katey Flowers, James Fotheringham, R. N. Andrea Fox, Gail Franklin, Claire Gardiner, R. N. Martin Gerrish, Sharlene Greenwood, Daljit Hothi, Abdul Khares, Pelagia Koufaki, Jeremy Levy, Elizabeth Lindley, Jamie Macdonald, Bruno Mafrici, Andrew Mooney, James Tattersall, Kay Tyerman, Enric Villar, Martin Wilkie

Published in: BMC Nephrology | Issue 1/2019

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Abstract

This guideline is written primarily for doctors and nurses working in dialysis units and related areas of medicine in the UK, and is an update of a previous version written in 2009. It aims to provide guidance on how to look after patients and how to run dialysis units, and provides standards which units should in general aim to achieve. We would not advise patients to interpret the guideline as a rulebook, but perhaps to answer the question: “what does good quality haemodialysis look like?”
The guideline is split into sections: each begins with a few statements which are graded by strength (1 is a firm recommendation, 2 is more like a sensible suggestion), and the type of research available to back up the statement, ranging from A (good quality trials so we are pretty sure this is right) to D (more like the opinion of experts than known for sure). After the statements there is a short summary explaining why we think this, often including a discussion of some of the most helpful research. There is then a list of the most important medical articles so that you can read further if you want to – most of this is freely available online, at least in summary form.
A few notes on the individual sections:
1.
This section is about how much dialysis a patient should have. The effectiveness of dialysis varies between patients because of differences in body size and age etc., so different people need different amounts, and this section gives guidance on what defines “enough” dialysis and how to make sure each person is getting that. Quite a bit of this section is very technical, for example, the term “eKt/V” is often used: this is a calculation based on blood tests before and after dialysis, which measures the effectiveness of a single dialysis session in a particular patient.
 
2.
This section deals with “non-standard” dialysis, which basically means anything other than 3 times per week. For example, a few people need 4 or more sessions per week to keep healthy, and some people are fine with only 2 sessions per week – this is usually people who are older, or those who have only just started dialysis. Special considerations for children and pregnant patients are also covered here.
 
3.
This section deals with membranes (the type of “filter” used in the dialysis machine) and “HDF” (haemodiafiltration) which is a more complex kind of dialysis which some doctors think is better. Studies are still being done, but at the moment we think it’s as good as but not better than regular dialysis.
 
4.
This section deals with fluid removal during dialysis sessions: how to remove enough fluid without causing cramps and low blood pressure. Amongst other recommendations we advise close collaboration with patients over this.
 
5.
This section deals with dialysate, which is the fluid used to “pull” toxins out of the blood (it is sometimes called the “bath”). The level of things like potassium in the dialysate is important, otherwise too much or too little may be removed. There is a section on dialysate buffer (bicarbonate) and also a section on phosphate, which occasionally needs to be added into the dialysate.
 
6.
This section is about anticoagulation (blood thinning) which is needed to stop the circuit from clotting, but sometimes causes side effects.
 
7.
This section is about certain safety aspects of dialysis, not seeking to replace well-established local protocols, but focussing on just a few where we thought some national-level guidance would be useful.
 
8.
This section draws together a few aspects of dialysis which don’t easily fit elsewhere, and which impact on how dialysis feels to patients, rather than the medical outcome, though of course these are linked. This is where home haemodialysis and exercise are covered.
 
There is an appendix at the end which covers a few aspects in more detail, especially the mathematical ideas. Several aspects of dialysis are not included in this guideline since they are covered elsewhere, often because they are aspects which affect non-dialysis patients too. This includes: anaemia, calcium and bone health, high blood pressure, nutrition, infection control, vascular access, transplant planning, and when dialysis should be started.
Appendix
Available only for authorised users
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Metadata
Title
Renal Association Clinical Practice Guideline on Haemodialysis
Authors
Damien Ashby
Natalie Borman
James Burton
Richard Corbett
Andrew Davenport
Ken Farrington
Katey Flowers
James Fotheringham
R. N. Andrea Fox
Gail Franklin
Claire Gardiner
R. N. Martin Gerrish
Sharlene Greenwood
Daljit Hothi
Abdul Khares
Pelagia Koufaki
Jeremy Levy
Elizabeth Lindley
Jamie Macdonald
Bruno Mafrici
Andrew Mooney
James Tattersall
Kay Tyerman
Enric Villar
Martin Wilkie
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2019
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-019-1527-3

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