Hemodialysis (HD)
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Solute removal across semipermeable membrane, countercurrent blood & dialysate flow
- Volume removal: Na/H2O ultrafiltered via transmembrane pressure (TMP) gradient
- Solutes: Cr, urea, K diffuse from blood → dialysate, HCO3 from dialysate → blood
- Solute removal inversely proportional to size ∴ effective removal of K, urea, Cr, not PO4
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6× vs. 3×/wk improved HTN, LV mass, QoL, but ↑ vasc issues (NEJM 2010;363:2287); w/ 3×/wk HD, ↑ mortality risk during 2-d interval (Sa–Tu or Fri–Mo) (NEJM 2011;365:1099)
參考➡️ In-center hemodialysis six times per week versus three times per week
- Fever w/ catheter: empiric abx (vanc + GNR coverage qHD). GPC >GNR >mixed/fungal. Remove/replace catheter (depends on organism), “lock” abx (JASN 2014;25:2927).
參考➡️ Systematic review and meta-analysis on management of hemodialysis catheter-related bacteremia