|
| Guideline | Recommendation/observations/frequency |
|
|
Dialysis prescription | |
| HD | |
| Dialyser | High-flux, high-efficiency |
| Duration and frequency | At least 20 h/week |
| Blood flow rate | 300 mL/min |
| Dialysate flow rate | 500 mL/min |
| Dialysate composition | Calcium 1.75 mmol/L, bicarbonate 25 mmol/L, and glucose 5 mmol/L |
| Weight review |
Weekly clinically + blood volume monitoring weekly |
| Fluid status | Prefered to leave “wet” as opposed to dry to avoid hypotension |
| Anticoagulation | Unfractionated heparin (1500 u bolus and 750 u hourly; off for the last 60 minutes) |
| Erythropoietin therapy | Recommendation to maintain haemoglobin > 110 g/L. May need higher doses |
| Iron therapy | Intravenous iron to maintain transferrin saturation > 25% |
| Vital signs | Each dialysis |
| Blood pressure parameters | Avoidance of hypotension imperative |
| ensure that phosphate binders and active vitamin D are adjusted as needed | |
| Pathology
*
| Perform full blood counts, electrolyte, and liver function tests weekly. Vitamin B12 checked every 3 months. Check dialysis adequacy using Kt/V ratio weekly. Other bloods as routinely done in dialysis patients |
| Haemoglobin | Maintain 110–120 g/L |
| Iron studies | Aim to achieve a transferrin saturation above 25% |
| Vitamin B12/folate | Suggest supplement folate 5 mg daily |
| Magnesium | Keep in normal range |
| Urea | Aim to keep pre-dialysis < 15 mmol/L |
| Bicarbonate | Keep in normal range before dialysis |
| Phosphate | When dialysis hours increased it is important to avoid low phosphate |
| Urate | Monitor levels |
| Diet
*
| |
| High protein | Dietician to review regularly |
| Supplements | Suggest folate 5 mg daily, vitamin B1 daily, vitamin D 1000 iu daily, and calcitriol (adjust according to phosphate and calcium) |
| Aspirin | To consider this in consultation with obstetric physicians/obstetricians |
| Fetal monitoring
*
| |
| Ultrasonography | Frequent to monitor growth discussision with obstetricians/obstetric physicians |
|
