This three-part document discusses hemodialysis prescription and targets. It begins with an introduction and overview of hemodialysis history and statistics on end-stage renal disease from the USRDS 2020 report. Part I covers breaking the news to patients about needing dialysis and variables in deciding on dialysis. Parts II and III will discuss choosing filters and dialysate composition, hemodynamics, ultrafiltration, and research aspects of optimizing hemodialysis prescription. The goal is targeting a dialysis treatment that is friendly to patients.

1. Hemodialysis prescription,
Targeting a friendly dialysis
Part I
Jafar Alsaid M.B.CHB.MD.FASN.FACP
Assistance Professor, Ochsner Clinical School/University of Queensland ( Australia)
Nephrology Consultant. Ochsner Health system.
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2. Hemodialysis Prescription,
Targeting a friendly dialysis
Part I
• Introduction.
• Historic points
• Statistics. USRDS 2020.
• How to break the news to the
patient.
• Variables in decision for Dialysis.
• Hemodialysis Targets.
• Hemodialysis Complications
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Part II
Choosing a Filter.
QB/QD.
Dialysis adequacy.
Anticoagulation in hemodialysis.
Part III
Hemodynamics and BP.
Ultrafiltration.
Temp.
Dialysate Na.
Dialysate Ca.
Online Volume Control
mode.
Research aspects.
Jafar Alsaid M.B.CHB.MD.FASN.FACP
Assistance Professor, Ochsner Clinical School/University of Queensland ( Australia)
Nephrology Consultant. Ochsner Health system.
8/13/2021 JAFAR ALSAID, MB.ChB. MD. FASN. FACP. AUG. 2021

3. Hemodialysis prescription,
Targeting a friendly dialysis
Part I
Jafar Alsaid M.B.CHB.MD.FASN.FACP
Assistance Professor, Ochsner Clinical School/University of Queensland ( Australia)
Nephrology Consultant. Ochsner Health system.
3
8/13/2021 JAFAR ALSAID, MB.ChB. MD. FASN. FACP. AUG. 2021

4. History of the kidney disease treatment (sgkpa.org.uk);
The first human dialysis machine
Dr. Willem Kolff (1911-2009) is considered by most to be the father of dialysis. This
young Dutch physician constructed the first dialyzer (artificial kidney) in 1943.
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5. CIN2003. Shaldon. PERSONAL HISTORY OF VASCULAR ACCESS (uninet.edu)
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6. Incidence
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7. Prevalence
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8. 113000
14000
3850
443
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9. 485000
230000
59000
10000
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10. 303
257
111
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11. 161
132
49
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12. 14
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13. 42
40
35
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14. 84
83
82
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15. 17
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16. 18
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17. You will need to start
dialysis
Access, nursing, on call, machine,
lunch time, leaving to home. End of life, Family, financial, work,
complication, pain, is it worth?
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18. Hemodialysis
Why?
When?
Which?
How?
What?
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19. Quality of life
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20. Quality of life
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21. https://www.dailymail.co.uk/news/article-2170881/Chinese-tightrope-walker-plummets-ground-trying-high-wire-stunt-
backwards-AND-blindfolded.html 23
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22. Can we make a difference?
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23. CONCLUSION
• ESRD incidence started to decreased since 2008 in US, but it had plateaued over a decade.
• ESRD prevalence is still increasing in US.
• The main increase is among ESRD receiving incenter HD.
• The minimum number is among patients receiving home hemodialysis.
• Although the annual mortality among ESRD patient is US is decreasing. It is still three times
more than any other medical disease including CVD and Cancer.
• The transplant mortality matched the other medical disease mortality in US, at one third
lower than Hemodialysis and PD mortality.
• The highest incidence of Mortality is within the first 3 months of initiation of dialysis.
• The probability of survival in US ESRD with Cadaveric Transplant is double that of Dialysis
patients.
• CV disease is the first cause of death among ESRD and Infection is the second cause.
• Quality of life should be one of the main variables taken in consideration upon initiation renal
replacement therapy.
• a balance between
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