1. What Do I want ???
Sudhakar Venturi
ST4

2. History
Dialysis – 1861
Thomas Graham, Professor of Chemistry at Anderson's University in Glasgow
He noticed that crystalloids were able to diffuse through vegetable parchment coated with albumin (which acted as a semi-permeable membrane).
Using this method he was able to extract urea from urine
He noticed that crystalloids were able to diffuse through vegetable parchment coated with albumin (which acted as a semi-permeable membrane). He called this "dialysis". Using this method he was able to extract urea from urine

3. WJ Kolff and H Berk (Netherlands)
George Haas (Germany)
First successful human dialysis
The dialysis lasted for 15 minutes with out any complications.
WJ Kolff and H Berk (Netherlands)
The first practical human haemodialysis machine.

4. One of Kolff's first artificial kidneys 1946-1950

5. Haemodialysis in the U K
Bywaters and Joekes - published a report on 12 patients treated with the artificial kidney at Hammersmith.
Dialysis for chronic renal failure
Quinton and Scribner (1960) – arteriovenous shunt was the key development.

6. 1967 - The only renal unit in Wales, at Cardiff Royal Infirmary

7. Renal Replacement Therapy
Haemodialysis
Institutional
Home
Conventional / Long duration
Nocturnal
Peritoneal Dialysis
CAPD
APD
Transplantation
Live
DBD/DCD

8. Nocturnal home Haemodialysis
Three to seven times per week at night during sleep, for six to ten hours
More total time dialyzing
shorter periods between treatments
fluid removal speeds can be lower and gradual.

9. Advantages of nocturnal home HD
Better blood pressure management
less need for BP medication.
Avoidance of intradialytic hypotension.
"Nocturnal hemodialysis increases arterial baroreflex sensitivity and compliance and normalizes blood pressure of hypertensive patients with end-stage renal disease". Kidney Int. (2005).

10. More energy and less 'wash-out' after treatment
Less dietary restrictions - Phosphate binders, food restrictions.

11. Cardiovascular disease in ESRD patients is the leading cause of mortality.
Nocturnal hemodialysis is proven to improve Ejection Fraction, lead to a regression in left ventricular hypertrophy
"Effect of Frequent Nocturnal Hemodialysis vs Conventional Hemodialysis on Left Ventricular Mass and Quality of Life". Journal of the American Medical Association (2007)
"Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis". Kidney Int.

12. Less expensive overall for the health system
due to lower rates of hospitalization
"Reduction in cardiovascular related hospitalization with nocturnal home hemodialysis". Clin. Nephrol. (2008).
More control over the dialysis treatment schedules - Greater life satisfaction
My Journey to Nocturnal Dialysis
Marion Higgins

13. Survival among NHHD patients compared to kidney transplant recipients, Robert P. Pauly and others Nephrology Dialysis and Transplantation, May 2009

14. Disadvantages of nocturnal home hemodialysis
Cost and effort
Longer duration of training
Home circumstances
Night sleep
Machine alarms. (Experience from Lynchburg suggests it happens once every 10 days for people using a fistula and 1-2 times per night if using a catheter)
NHHD - caregiver burden, depression, quality of life – Hemodialysis International (FEB 2012)

15. In Wales UHW – None Swansea – 3 + 1 Bangor – None Glan Clwyd – None
Wrexham - ?1

16. What Do I want NHHD Live related transplant – Identical twin
DBD preferred than DCD
Dialysis
Peritoneal Dialysis
Prefer APD with day dwells
Haemodialysis
NHHD

17. Thank You