What Do I want ??? Sudhakar Venturi ST4

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

WJ Kolff and H Berk (Netherlands) George Haas (Germany) First successful human dialysis - 1924. The dialysis lasted for 15 minutes with out any complications. WJ Kolff and H Berk (Netherlands) 1943 - The first practical human haemodialysis machine.

One of Kolff's first artificial kidneys 1946-1950

Haemodialysis in the U K 1948 - 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.

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

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

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.

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).

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

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.

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

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

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)

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

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

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