2HistoryDialysis – 1861Thomas Graham, Professor of Chemistry at Anderson's University in GlasgowHe 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 urineHe 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
3WJ Kolff and H Berk (Netherlands) George Haas (Germany)First successful human dialysisThe dialysis lasted for 15 minutes with out any complications.WJ Kolff and H Berk (Netherlands)The first practical human haemodialysis machine.
4One of Kolff's first artificial kidneys 1946-1950
5Haemodialysis in the U K Bywaters and Joekes - published a report on 12 patients treated with the artificial kidney at Hammersmith.Dialysis for chronic renal failureQuinton and Scribner (1960) – arteriovenous shunt was the key development.
61967 - The only renal unit in Wales, at Cardiff Royal Infirmary
7Renal Replacement Therapy HaemodialysisInstitutionalHomeConventional / Long durationNocturnalPeritoneal DialysisCAPDAPDTransplantationLiveDBD/DCD
8Nocturnal home Haemodialysis Three to seven times per week at night during sleep, for six to ten hoursMore total time dialyzingshorter periods between treatmentsfluid removal speeds can be lower and gradual.
9Advantages of nocturnal home HD Better blood pressure managementless 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).
10More energy and less 'wash-out' after treatment Less dietary restrictions - Phosphate binders, food restrictions.
11Cardiovascular 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.
12Less 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 satisfactionMy Journey to Nocturnal DialysisMarion Higgins
13Survival among NHHD patients compared to kidney transplant recipients, Robert P. Pauly and others Nephrology Dialysis and Transplantation, May 2009
14Disadvantages of nocturnal home hemodialysis Cost and effortLonger duration of trainingHome circumstancesNight sleepMachine 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)