2nd scenario

Mr. Y is doing well on 6 times weekly HHD prescription, however now wants to switch to 5 times weekly. His HHD prescription is 6 times week, 2 hr each, FF 0.4, BFR 400ml/min, Dialysate volume 20L

Vitals: PR 80/min, BP 138/90 mmHg
Wt 80 kg, Ht 160 cm, BMI 29.7
Exam: bilateral lung field clear, no lower extremity edema

Labs:
Na 137 meq/L, K 4.6 meq/L, Cl 103 meq/L, CO2 22meq/L, BUN 52 mg/dl, Cr 6.1 mg/dl

How to tailor HHD prescription in this situation?

Know frequency of dialysis session per week and calculate sp Kt/V.
  • (With permission from copyright holder.)
  • spKt/V changes from 0.5 to 0.6

Calculate dialysate volume. (assuming FF 40%, BFR 300ml/hr)

Hint: for this you need flow fraction, BFR, TBW

    Calculate time needed for each session for adequate clearance.

    Hint: you need Dialysate volume, Dialysate flow rate (DFR)

    • Dialysate volume is 25L, FF 0.4, BFR 300 ml/hr, DFR (ml/min)= FF x BFR (ml/min) = 0.4 x 300 =
      120 ml/min
      Time needed for adequate clearance (min) = Dialysate volume (ml)/DFR (ml/min)
      = 25,000/120 = 208 min = 3 hr 28 min

    Prescription is ready
    • Frequency: 5 times a week
    • FF 0.4
    • BFR 300 ml/min
    • DFR 120 ml/min
    • Dialysate volume= 25L
    • Minimum time for each session for clearance= 3 hr 28 min

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