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Clinical Practice Guideline Haemodialysis

Clinical Practice Guideline Haemodialysis Authors: Dr Damien Ashby - Chair Consultant Nephrologist, Hammersmith Hospital, Imperial College Healthcare NHS Trust Dr Natalie Borman Consultant Nephrologist, Wessex Kidney Centre, Portsmouth NHS Trust Dr James Burton Consultant Nephrologist, University Hospitals of Leicester NHS Trust Dr Richard Corbett Consultant Nephrologist, Hammersmith Hospital, Imperial College Healthcare NHS Trust Prof Andrew Davenport Consultant Nephrologist, Royal Free London NHS Foundation Trust Prof Ken Farrington Consultant Nephrologist, Lister Hospital, East & North Hertfordshire NHS Trust Dr Katey Flowers Nephrology Registrar, Wessex Kidney Centre.

Renal Association Clinical Practice Guideline Haemodialysis– July 2019 8 We recommend targeting dialysis dose to achieve a minimum eKt/V of 1.2 for thrice weekly patients, or a standardized Kt/V of 2.2 for those on augmented schedules.

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Transcription of Clinical Practice Guideline Haemodialysis

1 Clinical Practice Guideline Haemodialysis Authors: Dr Damien Ashby - Chair Consultant Nephrologist, Hammersmith Hospital, Imperial College Healthcare NHS Trust Dr Natalie Borman Consultant Nephrologist, Wessex Kidney Centre, Portsmouth NHS Trust Dr James Burton Consultant Nephrologist, University Hospitals of Leicester NHS Trust Dr Richard Corbett Consultant Nephrologist, Hammersmith Hospital, Imperial College Healthcare NHS Trust Prof Andrew Davenport Consultant Nephrologist, Royal Free London NHS Foundation Trust Prof Ken Farrington Consultant Nephrologist, Lister Hospital, East & North Hertfordshire NHS Trust Dr Katey Flowers Nephrology Registrar, Wessex Kidney Centre.

2 Portsmouth NHS Trust Dr James Fotheringham Consultant Nephrologist, Sheffield Teaching Hospitals NHS Foundation Trust Andrea Fox RN Deputy Director of Learning and Teaching, School of Nursing and Midwifery, University of Sheffield Gail Franklin Lead Clinical Specialist Dietitian, East & North Hertfordshire NHS Trust Final Version: July 2019 Review Date: July 2024 Renal Association Clinical Practice Guideline Haemodialysis July 2019 2 Claire Gardiner Senior Specialist Renal Dietitian, Leeds Teaching Hospitals NHS Trust Martin Gerrish RN Matron, United Lincolnshire Hospitals NHS Trust Dr Sharlene Greenwood Consultant Physiotherapist in Renal and Exercise Rehabilitation, King s College Hospital, London.

3 Dr Daljit Hothi Consultant Paediatric Nephrologist, Associate Medical Director, Great Ormond Street Hospital Mr Abdul Khares Haemodialysis Patient Dr Pelagia Koufaki Clinical Exercise Physiologist, School of Health Sciences, Queen Margaret University, Edinburgh Prof Jeremy Levy Consultant Nephrologist, Hammersmith Hospital, Imperial College Healthcare NHS Trust Dr Elizabeth Lindley Clinical Scientist, Department of Renal Medicine, Leeds Teaching Hospitals NHS Trust Dr Jamie Macdonald Head of School, School of Sport, Health and Exercise Sciences, Bangor University Bruno Mafrici Senior Specialist Renal Dietitian, Nottingham University Hospitals NHS Trust Prof Sandip Mitra Consultant Nephrologist, Manchester Royal Infirmary, Manchester University NHS Foundation Trust Dr Andrew Mooney Consultant Nephrologist, Leeds Teaching Hospitals NHS Trust Dr James Tattersall Consultant Nephrologist, Leeds Teaching Hospitals NHS Trust Dr Kay Tyerman Consultant Paediatric Nephrologist, Leeds Teaching Hospitals NHS Trust Dr Enric Villar Consultant Nephrologist, Lister Hospital, East & North Hertfordshire NHS Trust Prof Martin Wilkie Consultant Nephrologist.

4 Sheffield Teaching Hospitals NHS Foundation Trust Renal Association Clinical Practice Guideline Haemodialysis July 2019 3 Endorsements The National Institute for Health and Care Excellence (NICE) has accredited the process used by the Renal Association to produce its Clinical Practice guidelines . Accreditation is valid for 5 years from January 2017. More information on accreditation can be viewed at Method used to arrive at a recommendation The recommendations for the first draft of this Guideline resulted from a collective decision reached by informal discussion by the authors and, whenever necessary, with input from the Chair of the Clinical Practice guidelines Committee.

5 If no agreement had been reached on the appropriate grading of a recommendation, a vote would have been held and the majority opinion carried. However this was not necessary for this Guideline . Acknowledgements This document has been externally reviewed by key stake holders according to the process described in the Clinical Practice guidelines Development Policy Manual. Renal Association Clinical Practice Guideline Haemodialysis July 2019 4 Table of Contents 1. Introduction .. 5 2 Summary of clinicial Practice guidelines .. 7 3. Summary of audit measures.

6 13 4. Rationale for Clinical Practice guidelines .. 15 5. Lay summary .. 63 Appendices A. Simplified mathematics of urea clearance .. 65 B. Adjusting dialysis for residual function .. 68 C. Quantifying convection .. 69 D. Adding phosphate to dialysate .. 70 E. Haemodialysis tasks for shared care .. 71 F. Implementing intradialytic exercise .. 72 Renal Association Clinical Practice Guideline Haemodialysis July 2019 5 1. Introduction Haemodialysis continues to expand in the UK with over 25 000 patients now being treated, representing a 10% increase since publication of the previous Renal Association Guideline for Haemodialysis .

7 In addition the patient group continues to develop: the typical patient is now 67 years old with a median history of years on renal replacement therapy. The authors of this Guideline aimed principally to update the previous Guideline according to the latest research and experience, but also to expand the scope into areas not previously covered but relevant to Haemodialysis Practice . The Guideline was written collaboratively: lead and co-authors for each section conducted literature reviews and wrote first drafts of the statements and rationale. Feedback and discussion were provided by all authors via email exchanges and meetings, revised versions were produced with editorial input from the chair, and these were subsequently agreed by all authors.

8 Two current Haemodialysis patients gave advice on tone and readability. Systematic literature searches were undertaken by lead authors to identify all relevant evidence published up until the end of June 2018. Compound search terms were used which included a dialysis identifier (hemodialysis[tiab] OR Haemodialysis [tiab] OR dialysis[tiab]) followed by title/abstract-filtered topic terms ( dialysis dose , Kt/V, augmented, intensive, conservative, incremental, pregnancy, membrane, hydration, dry weight , fluid overload , dialysate, potassium, bicarbonate, buffer, phosphate, dialyser reaction , hypersensitivity, blood loss , needle dislodgment , exsanguination, home Haemodialysis , nocturnal Haemodialysis , exercise, physical training ) followed by negative terms ( to exclude animal studies and acute kidney injury)

9 Finally with date and language restrictions ("1990/01/01"[dp]: "3000"[dp] AND english[lang]). Searches were conducted in MEDLINE, PUBMED, Embase, and The Cochrane Library, and supplemented with papers handpicked from the reference lists of review papers. The strengths of the recommendations and the level of supporting evidence are coded as previously using the Modified GRADE system. There are a few changes in scope, for example dialysis water treatment is now covered in another Guideline , as are many aspects of dialysis, including: Planning, initiation & withdrawal of Renal Replacement Therapy Vascular Access for Haemodialysis Cardiovascular Disease Blood Borne Viruses Assessment of the Potential Kidney Transplant Recipient Nutrition Anaemia CKD-Mineral and Bone Disorder Water Treatment Facilities, Dialysis Water and Dialysis Fluid Quality We have removed the section on targets for blood testing since these are better covered in other guidelines , and have not covered infrastructure or workforce since these will be addressed separately by the Renal Association in a different format.

10 Renal Association Clinical Practice Guideline Haemodialysis July 2019 6 However, in most ways the update is broader than previous versions. For example, new sections have been written covering fluid management (surely an essential topic but not really covered previously or elsewhere) and dialysate (often underestimated in importance). In other areas this update seems to make no substantial change to previous guidance (as with dialysis dose, for example, where the literature remains dominated by previous large trials), however whilst key concepts remain valid, their understanding has developed, and the Guideline aims to provide greater context, encouraging a more holistic interpretation.


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