Hemodialysis Regimens and Prescriptions
The proliferation of hemodialysis (HD) regimens may be confusing to many; as such, this article aims to provide a summary of the accepted HD definitions. Conventional HD is the most common treatment for ESRD worldwide and is usually performed 3-5 hours, 3 days per week (1–4). Over past few decades, more frequent dialysis than the standard three-times-a week dialysis has been performed. Various terms (e.g., daily, nocturnal, short daily, daily nocturnal, quotidian, frequent, and intensive) HD have been used to characterize either longer duration, increased frequency or both (5). However, a standard nomenclature describing the HD prescriptions is lacking. Kidney Disease: Improving Global Outcomes (KDIGO) work group has proposed the following nomenclature to describe the different prescription as described in the Table 1 (5). Similarly, based on suggestion from KDIGO, the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) suggest that all HD prescriptions need to specify “duration of the individual dialysis session, the number of treatments per week, blood and dialysate flow rates, the location for HD treatment, and the level of assistance”; the proposed nomenclature is described in Table 2 (6).
Table 1: Descriptive nomenclature for hemodialysis frequency and duration (5)
|Conventional hemodialysis||3–5 h per session, three times per week|
|Short daily hemodialysis||Less than 3 h per session, six times per week|
|Standard daily hemodialysis||3–5 h per session, six times per week|
|Long daily hemodialysis||More than 5 h per session, six times per week|
Table 2: Descriptive nomenclature of various HD prescriptions (6)
|Proposed name||Time of day||Frequency (Sessions/wk.)||Duration (h/session)|
|Long thrice weekly||Nighttime or daytime||3||>5|
|Long every other night||Nighttime||3.5||>5|
|In-center||Outpatient treatment in a hospital or dialysis facility|
|Home||HD treatment in patient’s home|
Blood flow rate
|Low flow||<300 mL/min|
Dialysate flow rate
|Low flow||<500 mL/min|
a: Short and standard daily HD are usually delivered in-center, while long-nocturnal HD is usually delivered at home.
b: Long−thrice weekly HD may be delivered in-center or at home, while long every other night and frequent HD are usually delivered at home.
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P/N 102549-01 Rev A 02/2021