What Do I want ???What Do I want ???

Sudhakar Venturi

ST4

Sudhakar Venturi

ST4

HistoryHistory

Dialysis – 1861 Thomas Graham, Professor of Chemistry at

Anderson's University in Glasgow He noticed that crystalloids were able to diffuse

through vegetable parchment coated with albumin (which acted as a semi-permeable membrane).

Using this method he was able to extract urea from urine

Dialysis – 1861 Thomas Graham, Professor of Chemistry at

Anderson's University in Glasgow He noticed that crystalloids were able to diffuse

through vegetable parchment coated with albumin (which acted as a semi-permeable membrane).

Using this method he was able to extract urea from urine

George Haas (Germany) First successful human dialysis - 1924.

The dialysis lasted for 15 minutes with out any complications.

WJ Kolff and H Berk (Netherlands) 1943 - The first practical human haemodialysis

machine.

George Haas (Germany) First successful human dialysis - 1924.

The dialysis lasted for 15 minutes with out any complications.

WJ Kolff and H Berk (Netherlands) 1943 - The first practical human haemodialysis

machine.

One of Kolff's first artificial kidneys1946-1950

One of Kolff's first artificial kidneys1946-1950

Haemodialysis in the U KHaemodialysis in the U K 1948 - Bywaters and Joekes - published a

report on 12 patients treated with the artificial kidney at Hammersmith.

Dialysis for chronic renal failure Quinton and Scribner (1960) – arteriovenous

shunt was the key development.

1948 - Bywaters and Joekes - published a report on 12 patients treated with the artificial kidney at Hammersmith.

Dialysis for chronic renal failure Quinton and Scribner (1960) – arteriovenous

shunt was the key development.

1967 - The only renal unit in Wales, at Cardiff Royal Infirmary

1967 - The only renal unit in Wales, at Cardiff Royal Infirmary

Renal Replacement TherapyRenal Replacement Therapy Haemodialysis

Institutional Home

Conventional / Long duration Nocturnal

Peritoneal Dialysis CAPD APD

Transplantation Live DBD/DCD

Haemodialysis Institutional Home

Conventional / Long duration Nocturnal

Peritoneal Dialysis CAPD APD

Transplantation Live DBD/DCD

Nocturnal homeHaemodialysis Nocturnal homeHaemodialysis

Three to seven times per week at night during sleep, for six to ten hours More total time dialyzing shorter periods between treatments fluid removal speeds can be lower and gradual.

Three to seven times per week at night during sleep, for six to ten hours More total time dialyzing shorter periods between treatments fluid removal speeds can be lower and gradual.

Advantages of nocturnal home HDAdvantages of nocturnal home HD Better blood pressure management

less need for BP medication.

Avoidance of intradialytic hypotension. "Nocturnal hemodialysis increases arterial baroreflex sensitivity

and compliance and normalizes blood pressure of hypertensive

patients with end-stage renal disease". Kidney Int. (2005).

Better blood pressure management less need for BP medication.

Avoidance of intradialytic hypotension. "Nocturnal hemodialysis increases arterial baroreflex sensitivity

and compliance and normalizes blood pressure of hypertensive

patients with end-stage renal disease". Kidney Int. (2005).

More energy and less 'wash-out' after treatment

Less dietary restrictions - Phosphate binders, food restrictions.

More energy and less 'wash-out' after treatment

Less dietary restrictions - Phosphate binders, food restrictions.

Cardiovascular disease in ESRD patients is the leading cause of mortality. Nocturnal hemodialysis is proven to improve

Ejection Fraction, lead to a regression in left ventricular hypertrophy

"Effect of Frequent Nocturnal Hemodialysis vs Conventional Hemodialysis on Left Ventricular Mass and Quality of Life". Journal of the American Medical Association (2007)

"Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis". Kidney Int.

Cardiovascular disease in ESRD patients is the leading cause of mortality. Nocturnal hemodialysis is proven to improve

Ejection Fraction, lead to a regression in left ventricular hypertrophy

"Effect of Frequent Nocturnal Hemodialysis vs Conventional Hemodialysis on Left Ventricular Mass and Quality of Life". Journal of the American Medical Association (2007)

"Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis". Kidney Int.

Less expensive overall for the health system due to lower rates of hospitalization

"Reduction in cardiovascular related hospitalization with

nocturnal home hemodialysis". Clin. Nephrol. (2008).

More control over the dialysis treatment schedules - Greater life satisfaction

My Journey to Nocturnal Dialysis Marion Higgins

Less expensive overall for the health system due to lower rates of hospitalization

"Reduction in cardiovascular related hospitalization with

nocturnal home hemodialysis". Clin. Nephrol. (2008).

More control over the dialysis treatment schedules - Greater life satisfaction

My Journey to Nocturnal Dialysis Marion Higgins

Survival among NHHD patients compared to kidney

transplant recipients, Robert P. Pauly and others Nephrology Dialysis and Transplantation, May 2009

Survival among NHHD patients compared to kidney

transplant recipients, Robert P. Pauly and others Nephrology Dialysis and Transplantation, May 2009

Disadvantages of nocturnal home hemodialysis

Disadvantages of nocturnal home hemodialysis

Cost and effort Longer duration of training Home circumstances Night sleep

Machine alarms. (Experience from Lynchburg suggests it happens once every 10 days for people using a fistula and 1-2

times per night if using a catheter) NHHD - caregiver burden, depression, quality of life –

Hemodialysis International (FEB 2012)

Cost and effort Longer duration of training Home circumstances Night sleep

Machine alarms. (Experience from Lynchburg suggests it happens once every 10 days for people using a fistula and 1-2

times per night if using a catheter) NHHD - caregiver burden, depression, quality of life –

Hemodialysis International (FEB 2012)

In WalesIn Wales

UHW – None Swansea – 3 + 1 Bangor – None Glan Clwyd – None Wrexham - ?1

UHW – None Swansea – 3 + 1 Bangor – None Glan Clwyd – None Wrexham - ?1

What Do I wantWhat Do I want

Live related transplant – Identical twin Live related transplant DBD preferred than DCD Dialysis Peritoneal Dialysis

Prefer APD with day dwells

Haemodialysis

NHHD

Live related transplant – Identical twin Live related transplant DBD preferred than DCD Dialysis Peritoneal Dialysis

Prefer APD with day dwells

Haemodialysis

NHHD

Thank You Thank You