Transcription of STANDARD TREATMENT GUIDELINES HAEMODIALYSIS
1 _____ GUIDELINES for Maintenance Hemodialysis in India STANDARD TREATMENT GUIDELINES HAEMODIALYSIS Ministry of Health & Family Welfare Govt. of India _____ GUIDELINES for Maintenance Hemodialysis in India STANDARD OF CARE FOR MAINTAINANCE HEMODIALYSIS IN INDIA Developed By INDIAN SOCIETY OF NEPHROLOGY _____ GUIDELINES for Maintenance Hemodialysis in India AUTHORS DECLARATION All the authors have no conflict of interest.
2 The chapters were written at the request of Indian Society of Nephrology. No remuneration was paid to the authors of the chapter. The chapters were then given to Ms. Shachi Vyas, Medical Writer for converting the chapters into standardized style without changing the original content. Authors of this guideline were: Sr. No Topic Author s Signature& Date 1 Setting up of hemodialysis unit for maintenance hemodialysis Kher Chairman Deptt. of Nephrology & Transplant Medicine Medanta Kidney & Urology Institute, Medanta - The Medicity Gurgaon, Dr. Mohan Rajapurkar, MD Director, Postgraduate Studies & Research, Muljibhai Patel Urological Hospital, Nadiad 2 Personnel for hemodialysis unit for maintenance hemodialysis Dr. Abhijit Taraphder, MD. DM Chief Academics & Research, Senior Consultant, Department of Nephrology Apollo Gleneagles Hospital, Kolkata.
3 Dr. Dhananjay Ookalkar Consultant nephrologist Ashwini Kidney & dialysis Centre, Nagpur 3 Selection of Machine and dialyser unit for maintenance hemodialysis Dr. Rajeev Annigeri Consultant Nephrologist Apollo Hospitals, Chennai 4 Water TREATMENT for hemodialysis Dr. Mohan Rajapurkar, MD Director, Postgraduate Studies & Research, Muljibhai Patel Urological Hospital, Nadiad 5 Vascular access Dr. Valentine Lobo, Consultant Nephrologist KEM Hospital, Pune _____ GUIDELINES for Maintenance Hemodialysis in India 6 Priming, connecting & disconnecting dialyser Dr. Amit Gupta MD, DNB, FRCP Professor of Nephrology, SGPGIMS, Lucknow 7 Anti-coagulation in hemodialysis Dr.
4 Abhijit Taraphder, MD. DM Chief Academics & Research, Senior Consultant, Department of Nephrology Apollo Gleneagles Hospital, Kolkata. Dr. Dhananjay Ookalkar Consultant nephrologist Ashwini Kidney & dialysis Centre, Nagpur 8 Dialyser reuse (Manual & automated) Dr. Valentine Lobo, Consultant Nephrologist KEM Hospital, Pune 9 dialysis dose/ adequacy Dr. Vijay Kher Chairman Deptt. of Nephrology & Transplant Medicine Medanta Kidney & Urology Institute, Medanta - The Medicity Gurgaon 10 Prevention of infections in hemodialysis Unit Dr. Vivekand Jha,MD, DM Secretary ISN Additional Professor of Nephrology Postgraduate Institute of Medical Education and Research Chandigarh Dr. Amit Gupta MD, DNB, FRCP Professor of Nephrology, SGPGIMS, Lucknow 11 Emergency services Dr. Ravi Raju President, ISN Director of Medical Education _____ GUIDELINES for Maintenance Hemodialysis in India Government of Andra Pradesh Hyderabad 12 Laboratory back up Dr.
5 Ravi Raju President, ISN Director of Medical Education Government of Andra Pradesh Hyderabad 13 Nutrition Dr Anita Saxena PhD,PhD(Cantab) Assistant Professor Nephrology, SGPGIMS, Lucknow 14 CVD Monitoring & therapy Dr. Mohan Rajapurkar, MD. Director, Postgraduate Studies & Research, Muljibhai Patel Urological Hospital, Nadiad 15 MBD monitoring & Therapy Jha, MD, DM Secretary ISN Additional Professor of Nephrology Postgraduate Institute of Medical Education and Research Chandigarh 16 Hypertension monitoring & Therapy Dr. Vijay Kher Chairman Deptt. of Nephrology & Transplant Medicine Medanta Kidney & Urology Institute, Medanta - The Medicity Gurgaon, 17 Diabetes monitoring & therapy Dr. Amit Gupta MD, DNB, FRCP Professor of Nephrology, SGPGIMS, Lucknow 18 Renal replacement in Intensive care setting _____ Dr.
6 Valentine Lobo, _____ GUIDELINES for Maintenance Hemodialysis in India Dr. Rajeev Annigeri Consultant Nephrologist Apollo Hospitals, Chennai Consultant Nephrologist KEM Hospital, Pune Please send feedback to with a copy to _____ GUIDELINES for Maintenance Hemodialysis in India TABLE OF CONTENTS Contents Title AUTHORS DECLARATION .. 3 TABLE OF CONTENTS .. 7 LIST OF ABBREVIATIONS .. 8 INTRODUCTION .. 11 UP OF HEMODIALYSIS UNIT FOR MAINTENANCE HEMODIALYSIS .. 13 PERSONNEL FOR HEMODIALYSIS UNIT FOR MAINTENANCE HEMODIALYSIS.
7 17 SELECTION OF MACHINE AND DIALYSER UNIT FOR MAINTENANCE 24 WATER TREATMENT FOR HEMODIALYSIS .. 36 VASCULAR ACCESS .. 44 PRIMING, CONNECTING AND DISCONNECTING DIALYSER .. 51 11. ANTICOAGULATION IN HAEMODIALYSIS .. 55 12. DIALYSER REUSE (MANUAL & AUTOMATED) .. 60 13. dialysis DOSE/ adequacy .. 68 14. PREVENTION OF INFECTIONS IN HEMODIALYSIS UNIT .. 71 SCHEDULE I-CATEGORIES OF BIO-MEDICAL WASTE .. 80 SCHEDULE II- COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF BIO-MEDICAL WASTES .. 82 SCHEDULE III- LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS .. 83 15. EMERGENCY SERVICES .. 85 16. LABORATORY BACKUP .. 88 17. NUTRITION .. 96 18. CVD MONITORING & THERAPY .. Error! Bookmark not defined. 19. MBD MONITORING & THERAPY .. 114 20. HYPERTENSION & THERAPY .. 118 21. DIABETES MONITORING & THERAPY.
8 123 22. RENAL REPLACEMENT IN INTENSIVE CARE SETTING .. 126 _____ GUIDELINES for Maintenance Hemodialysis in India LIST OF ABBREVIATIONS AAMI : Association for the Advancement of Medical Instrumentation ACE angiotensin-converting enzyme ACLS : Advanced cardiac life support ACT American College Testing AKI acute kidney injury ALP Alkaline phosphatase Amps : Ampere APTT activated partial thromboplastin time ARB angiotensin receptor blockers AV Atrioventricular BBV Blood Borne Virus BUN blood urea nitrogen BP Blood pressure CAPD Continuous Ambulatory Peritoneal dialysis CAG Coronary Angiography CFU : Colony forming unit CNS Central nervous system CKD : Chronic Kidney Disease cm Centimeter CRRT.
9 Continuous renal replacement therapy CPR : Cardiopulmonary Resuscitation CPKMB Creatine phosphokinase, muscle band CT Computed tomography CVD : Cerebrovascular disease CVS cardiovascular system DM : diabetes mellitus DNB : Diplomate of National Board ECG : Electrocardiogram EIA enzyme immunoassay EKG electrocardiogram EPO Erythropoietin ESR Erythrocyte sedimentation rate ESRD : End stage renal disease EU European Union G Gauge GFR Glomerular filtration rate GI Gastrointestinal Hb Hemoglobin _____ GUIDELINES for Maintenance Hemodialysis in India HbA1C Glycosylated hemoglobin (HbA1c or HbA1c) HBV : Hepatitis B virus HCV : Hepatitis C virus HD : Hemodialysis HIT Heparin-Induced Thrombocytopenia HIV Human immunodeficiency virus Hr Hour ICU Intensive care unit IU/kg International unit/kilogram IV : Intravenous IVC Inferior vena cava Kg/cm2 Kilogram/square centimeter LAL Limulus Amebocyte Lysate LDH Lactate dehydrogenase LPS Lipopolysaccharide LV Left ventricular LVF Left ventricular failure LVH Left ventricular hypertrophy : Bachelor of Medicine, Bachelor of Surgery degree MBD : Mineral and Bone Disorder MD : Doctor of Medicine Mg/l milligrams per litre MHD.
10 Maintenance hemodialysis MI Myocardial infarction MIBI Methoxyisobutyl Isonitrile Stress ml/min Milliliter per minute mmol/L Milli moler per liter mmHg millimetres of mercury Micron N Normal NAT nucleic acid test NKF National Kidney Foundation PCR protein catabolic rate pH potential of hydrogen Psi per square inch PTFE Polytetrafluoroethylene PTH Parathyroid hormone PVC : Polyvinylchloride PT Prothrombin R2A R2A Agar RO Reversed osmosis RRT Renal Replacement Therapy _____ GUIDELINES for Maintenance Hemodialysis in India Secs Seconds SGPT serum glutamic pyruvic transaminase SGOT serum glutamic oxaloacetic transaminase spkt v single pool Kt/V Sq.
