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Nephrology Dialysis Transplantation 2007 22(Supplement 2):ii5-ii21; doi:10.1093/ndt/gfm022
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. for Permissions, please email: journals.permissions@oxfordjournals.org

EBPG guideline on dialysis strategies

James Tattersall1, Alejandro Martin-Malo2, Luciano Pedrini3, Ali Basci4, Bernard Canaud5, Denis Fouque6, Patrick Haage7, Klaus Konner8, Jeroen Kooman9, Francesco Pizzarelli10, Jan Tordoir11, Marianne Vennegoor12, Christoph Wanner13, Piet ter Wee14 and Raymond Vanholder15

1Department of Renal Medicine, St James's University Hospital, Leeds, UK, 2Nephrology Department, Reina Sofia University Hospital, Cordoba, Spain, 3Division of Nephrology and Dialysis, Bolognini Hospital, Seriate, Italy, 4Department of Medicine, Division of Nephrology, Ege University Medical Faculty, Izmir, Turkey, 5Nephrology, Dialysis and Intensive Care Unit, Lapeyronie University Hospital, Montpellier, France, 6Département de Néphrologie JE 2411 - Dénutrition des Maladies Chroniques, Hôpital E Herriot, France, 7Department of Diagnostic and Interventional Radiology, Helios Klinikum Wuppertal, University Hospital Witten/Herdecke, Germany, 8Medical Faculty University of Cologne, Medicine Clinic I, Hospital Merheim, Germany (retired), 9Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht, The Netherlands, 10Nephrology Unit, SM Annunziata Hospital, Florence, Italy, 11Department of Surgery, University Hospital Maastricht, The Netherlands, 12Department of Nephrology, Nutrition and Dietetics, Guy's and St Thomas’ NHS Foundation Trust, London, UK (retired), 13Department of Medicine, Division of Nephrology, University Hospital, Würzburg, Germany, 14Department of Nephrology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands and 15Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium

Correspondence and offprint requests to: James Tattersall, MD, MRCP, Department of Renal Medicine, St James's University Hospital, Leeds, LS9 7TF, UK. Email: jamestattersall@doctors.org.uk

Outline

Guideline 1. Time and frequency

1.1 Minimum length and frequency of sessions.

1.2 Cardiovacular instability.

1.3 Hypertension.

1.4 Hyperphosphataemia.

1.5 Malnutrition.

Guideline 2. Flux and convection

2.1 High-flux dialysis

2.2 Haemodiafiltration.

Guideline 3. Dialysis dose methodology

3.1 Frequency of dose estimation.

3.2 Reference method.

3.3 Renal function.

3.4 Standardizing terminology.

Guideline 4. Minimum adequate dialysis dose

4.1 Anuric patients treated by thrice weekly dialysis.

4.2 Patients with renal function or dialysis schedulesother than thrice weekly.

The first 150 words of the full text of this article appear below.



   1. Time and frequency
 

Guideline 1.1
Dialysis should be delivered at least 3 times per week and the total duration should be at least 12 h per week, unless supported by significant renal function. See also Guideline 4.1. (Evidence level III)

Guideline 1.2
An increase in treatment time and/or frequency should be considered in patients with haemodynamic or cardiovascular instability. (Evidence level II)

Guideline 1.3
Dialysis treatment time and/or frequency should be increased in patients who remain hypertensive despite maximum possible fluid removal. (Evidence level III)

Guideline 1.4
An increase of treatment time and/or frequency should be considered in patients with impaired phosphate control. (Evidence level III)

Guideline 1.5
An increase of dialysis time and/or frequency should be considered in malnourished patients. (Opinion)

 

Rationale
Definitions of dialysis schedules
Due to high mortality and morbidity rates and, inter and intradialytic symptoms associated with conventional intermittent HD three times a week, different modalities of HD treatment based on variations in dialysis . . . [Full Text of this Article]

Are there specific indications for increasing the duration of HD?
Impact on mortality
Can the effects of increased time be separated from increased dose?
Are there specific indications for increasing frequency?
Potential disadvantages
Summary
Particular advantages of daily long nocturnal HD
Particular limitations of daily long nocturnal HD
Daily haemodiafiltration
Can the effects of increased frequency be separated from increasing time?


   References
 


   2. Flux and convection
 
Rationale
Solute removal in high-flux haemodialysis
Solute removal in haemofiltration/haemodiafiltration
Clinical results of increasing flux
Outcome in high-flux HD and HDF/HF


   Summary of evidence
 


   References
 


   3. Dialysis dose methodology
 
Rationale
Frequency of adequacy testing
Method of adequacy testing, need for a reference method
Trouble shooting and validation
Other methods for calculating adequacy
Dialysis frequency other than three times per week
Taking renal function into account


   References
 


   4. Minimum adeqate dialysis
 
Rationale
Three times per week dialysis
More frequent dialysis than three times per week
Twice weekly dialysis
Higher doses of dialysis


   References
 

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