Hemodialysis Regimens and Prescriptions
The proliferation of hemodialysis (HD) regimens may be confusing to many; as such, this article aims to provide a summary of the accepted HD definitions. Conventional HD is the most common treatment for ESRD worldwide and is usually performed 3-5 hours, 3 days per week (1–4). Over past few decades, more frequent dialysis than the standard three-times-a week dialysis has been performed. Various terms (e.g., daily, nocturnal, short daily, daily nocturnal, quotidian, frequent, and intensive) HD have been used to characterize either longer duration, increased frequency or both (5). However, a standard nomenclature describing the HD prescriptions is lacking. Kidney Disease: Improving Global Outcomes (KDIGO) work group has proposed the following nomenclature to describe the different prescription as described in the Table 1 (5). Similarly, based on suggestion from KDIGO, the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) suggest that all HD prescriptions need to specify “duration of the individual dialysis session, the number of treatments per week, blood and dialysate flow rates, the location for HD treatment, and the level of assistance”; the proposed nomenclature is described in Table 2 (6).
Table 1: Descriptive nomenclature for hemodialysis frequency and duration (5)
| Conventional hemodialysis | 3–5 h per session, three times per week |
| Short daily hemodialysis | Less than 3 h per session, six times per week |
| Standard daily hemodialysis | 3–5 h per session, six times per week |
| Long daily hemodialysis | More than 5 h per session, six times per week |
Table 2: Descriptive nomenclature of various HD prescriptions (6)
| Proposed name | Time of day | Frequency (Sessions/wk.) | Duration (h/session) |
| Conventional HD | Daytime | 3-4 | 3-5 |
| Frequent HDa | |||
| Short | Daytime | 5-7 | <3 |
| Standard | Daytime | 5-7 | 3-5 |
| Long | Nighttime | 5-7 | >5 |
| Long HDb | |||
| Long thrice weekly | Nighttime or daytime | 3 | >5 |
| Long every other night | Nighttime | 3.5 | >5 |
| Long frequent | Nighttime | 5-7 | >5 |
|
Treatment Location |
|||
| In-center | Outpatient treatment in a hospital or dialysis facility | ||
| Home | HD treatment in patient’s home | ||
|
Blood flow rate |
|||
| Standard | ≥300 mL/min | ||
| Low flow | <300 mL/min | ||
|
Dialysate flow rate |
|||
| Standard | ≥500 mL/min | ||
| Low flow | <500 mL/min | ||
a: Short and standard daily HD are usually delivered in-center, while long-nocturnal HD is usually delivered at home.
b: Long−thrice weekly HD may be delivered in-center or at home, while long every other night and frequent HD are usually delivered at home.
References:
- Saran R, Robinson B, Abbott KC, Bragg-Gresham J, Chen X, Gipson D, Gu H, Hirth RA, Hutton D, Jin Y, Kapke A, Kurtz V, Li Y, McCullough K, Modi Z, Morgenstern H, Mukhopadhyay P, Pearson J, Pisoni R, et al. US Renal Data System 2019 Annual Data Report: Epidemiology of Kidney Disease in the United States.Am J Kidney Dis. 2020;75(1, Supplement 1):A6-A7.
- Wile C. Kidney disease in Canada: highlights from the Canadian Institute for Health Information Annual Report.CANNT J. 2012;22(2):12. www.ncbi.nlm.nih.gov/pubmed/22913045
- Kramer A, Boenink R, Stel VS, Santiuste de Pablos C, Tomović F, Golan E, Kerschbaum J, Seyahi N, Ioanou K, Beltrán P, Zurriaga O, Magaz Á, Slon Roblero MF, Gjorgjievski N, Garneata L, Arribas F, Galvão AA, Bell S, Ots-Rosenberg M, et al. The ERA-EDTA Registry Annual Report 2018: a summary.Clin Kidney J. 2021;14(1):107-123.
- Gray NA, Dent H, McDonald SP. Renal replacement therapy in rural and urban Australia.Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc – Eur Ren Assoc. 2012;27(5):2069-2076. www.ncbi.nlm.nih.gov/pubmed/21984553
- Chan CT, Covic A, Craig JC, Davenport A, Kasiske BL, Kuhlmann MK, Levin NW, Li PKT, Locatelli F, Rocco M V, Wheeler DC. Novel techniques and innovation in blood purification: a clinical update from Kidney Disease: Improving Global Outcomes.Kidney Int. 2013;83(3):359-371. www.ncbi.nlm.nih.gov/pubmed/23325091
- Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco M V., Suri RS, Weiner DE, Greer N, Ishani A, MacDonald R, Olson C, Rutks I, Slinin Y, Wilt TJ, Rocco M, Kramer H, Choi MJ, Samaniego-Picota M, Scheel PJ, et al. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update.Am J Kidney Dis. 2015;66(5):884-930.
P/N 102549-01 Rev A 02/2021