3rd scenario

Mr. Z reports feeling nauseous most of the time and has poor appetite. He is currently on HHD for last 6 months and his prescription is 5 times a week, each session 2.5 hr duration, Dialysate volume: 20 L, FF 40 %, BFR 300 ml/hr

Vitals: PR 86/min, BP 144/94 mmHg
Wt 100 kg, Ht 160 cm
Exam: bilateral lung field clear, no lower extremity edema

Labs:
Na 132 meq/L, K 5.3 meq/L, Cl 102 meq/L, CO2 22meq/L, BUN 75 mg/dl, Cr 8.6 mg/dl

How to tailor HHD prescription in this situation?

Let us review what is the clearance on current HHD prescription and determine factors that affect clearance

You decided to try increasing dialysate volume for better clearance. You changed DV to 30 L

Lets try decreasing time by keeping high dialysate volume but increasing DFR.

Remember time of each session = Dialysate volume/ Dialysate flow rate

Prescription is ready
  • Frequency: 6 times a week
  • FF 0.5
  • BFR 400 ml/min
  • DFR 200 ml/min
  • Dialysate volume= 30 L
  • Minimum time for each session for clearance= 2 hr 30 min

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