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55 year old female with diabetes, hypertension, prior stroke, prior surgery for ovarian cyst and ESKD is maintained on in-center HD for last 10 months via a left brachio-basilic AVF. She lives with her husband and is a teacher by profession. She reports that she feels frustrated waiting for her turn at in-center hemodialysis unit and scared of risk of infections. Do you think she will be a good home hemodialysis candidate?
Do you think she will be good home hemodialysis candidate?
You discuss home therapies with her and she is eager to get more information. She does not want to get additional surgery for peritoneal dialysis catheter but is eager to know more about home hemodialysis. She meets with the home therapy nurse and begins her training.
Which one of the following has been shown to help transition to home hemodialysis.
Her home training has finished and she has successfully cannulated her fistula in the transition care unit. Her home has been inspected and evaluated by an engineer and home nurse. She is expected to start home hemodialysis next week but is very apprehensive doing it alone. What will be the next step?
Yes. This is Correct.
Patient is expected to show that she is able to complete all the steps independently and should pass the exam evaluating her knowledge regarding the dialysis and immediate complication management. Home therapy nurse is present for first few sessions and help ensure safety.Let us calculate the urea kinetics for an 60 kg female (height 160 cm, age 55 years), who will perform home hemodialysis 5 times a week using the low dialysate approach. What is the single pool Kt/V for this?
Yes. This is Correct.
(With permission from copyright holder.) Calculate the volume of distribution of urea for 55 years old female. (weight 60 kg, height 160 cm)
Yes. This is Correct.
It is about 30 L [the most common equation to calculate the total body water from weight is the Watson equation, or 0.42 x weight (female), 0.5 x weight (male) ]https://qxmd.com/calculate/calculator_233/volume-of-distribution-of-urea
Calculate the volume of dialysate required for the home hemodialysis prescription for 55 year old female who wants to do 5 dialysis session per week. (FF 40%, BFR 400 ml/min, TBW 30L)
Yes. This is Correct.
Calculate the minimum time required for each home hemodialysis session to achieve adequate clearance, given that she wants to do dialysis no more than 5 times a week. Take Qb 400ml/min, FF 40%, TBW 30 L, negligible ultrafiltration, dialysate volume 20L.
Yes. This is Correct.
Dialysate volume = 20LFF = 0.4 = Qd/Qb
Qb is 400 ml per minute.
Thus Qd = 0.4 x 400 = 160 ml per minute.
Time on dialysis = Dialysate volume/Qd
The time on treatment is determined by the dialysate volume and the dialysate flow, which is, 20000/160, about 125 minutes, or 2 hours 5 minutes.
You notice that her blood pressure is above goal and she appears volume overloaded. She is having high inter-dialytic weight gain. Calculate the minimum time required for each home hemodialysis session to target fluid removal of 2 L per day given that she wants to do dialysis no more than 5 times a week. Take Qb 400ml/min, FF 40%, TBW 30 L, weight 60 kg
Yes. This is Correct.
Max UFR is 8 ml/kg/hr = 8 x 60 = 480 ml/hrSo, to achieve ultrafiltration of 2 L per session, time on each session should be 2000/480 = 4.1 hr = 4hr 6 min