Transcript Making a diagnosis of aspergillosis in ITU

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
 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
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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
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UHW – None
Swansea – 3 + 1
Bangor – None
Glan Clwyd – None
Wrexham - ?1
What Do I want
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Live related transplant – Identical twin
Live related transplant
DBD preferred than DCD
Dialysis
Peritoneal Dialysis
 Prefer APD with day dwells
 Haemodialysis
 NHHD
Thank You