| Theme |
Diversity of hemodialysis therapies |
| Title |
Long nocturnal hemodialysis |
| Author |
Hiroshi Kaneda |
Department of Internal Medicine, Kamome Minatomirai Clinic |
| Author |
Toshiro Nishiyama |
Department of Clinical Engineering, Kamome Minatomirai Clinic |
| Author |
Kunihiro Kiyomatsu |
Department of Clinical Engineering, Kamome Minatomirai Clinic |
| Author |
Tomomi Nagaki |
Department of Nursing, Kamome Minatomirai Clinic |
| Author |
Kayoko Oohira |
Department of Nursing, Kamome Minatomirai Clinic |
| Author |
Mitsuaki Umemoto |
Department of Internal Medicine, Kamome Minatomirai Clinic |
| [ Summary ] |
Long nocturnal hemodialysis in combination with free of diet restriction can provide improved control of blood pressure as well as control of nutrition. Significant restoration of patient's conditions was observed in 51 maintenance hemodialysis patients who received this treatment. Over a period of approximately four years, from August 2008, to November 2012 these patients were treated in our dialysis facility in Yokohama with weekly 3 × 8hr HD sessions and a virtually free of diet restriction. Radiant cooling provided by the Toyox Co. Ltd. was used to cover each dialysis bed. Venipuncture was conduced between 20:00 and 22:00, followed by blood pressure monitoring. Time of lights out was 23:00. Monitoring of blood pressure ceased at that time except when seen to be necessary due to medical incidents. Observation of patients' vital signs continued using a Blood Volume Monitoring system made by the Nikkiso Co. Ltd. Between 04:00 and 06:00 dialysis was terminated. Patients were served breakfast and went out to conduct their normal daily routines. No sever incidents due to excessive bleeding during needle extraction or death due to hypotensive shock were reported during the four-year period. It was only deemed necessary to discontinue therapy when conditions such as abdominal pain due to gallstones or fever due to colds were present. Of the patients' safety during dialysis the following two seems to be exclusively important. The first is the selection of dialysis modality which induces better blood pressure control. When patients undergoing nocturnal hemodialysis have received a large number of antihypertensive drugs they may frequently encounter the hypotensive shock during the therapy. The second is also the selection of dialysis modality which achieves better nutritional state. When patients are to be a lack of nourishment frequently observed in Japanese standard hemodialysis patients who have been treated with weekly a 3 x 4hr HD with strict restriction of salt intake they may also frequently tend to induce the hypotensive shock without restoration during dialysis. Thus, the choice of dialysis modality which simultaneously facilitates better blood pressure and nutrition control is the utmost important for successful achievement of nocturnal hemodialysis treatment without the occurrence of severe accidents. The dialysis modality satisfied them above mentioned may be the long hemodialysis with almost free diet, that is, prolonged slow dialysis on an ad libitum sodium intake which had been developed by us since 1998. |