Home haemodialysis
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EDUCATIONAL REVIEW
Home haemodialysis Daljit K. Hothi & Lynsey Stronach & Elizabeth Harvey
Received: 3 June 2012 / Revised: 12 August 2012 / Accepted: 13 August 2012 / Published online: 3 November 2012 # IPNA 2012
Abstract Haemodialysis (HD) began as an intensive care treatment offered to a very select number of patients in an attempt to keep them alive. Outcomes were extremely poor, and the procedure was cumbersome and labor intensive. With increasing expertise and advances in dialysis equipment, HD is now recognised as a life-sustaining treatment that is considered a standard of care for children with end stage renal disease (ESRD). Assessment of efficacy has evolved from mere survival, through achieving minimal standards of “adequate” dialysis with reduced morbidity, towards the provision of “optimal dialysis”, which includes attempts to more closely mimic normal renal function, and of individualised care that maximizes the patient’s health, psychosocial well-being and life potential. There is a renewed interest in dialysis, and the research profile has extended, exploring themes around convective versus diffusive treatments, HD time versus frequency and home versus in-centre dialysis. The results thus far have led dialysis care full circle from prolonged, home-based therapies to shorter, intense in-centre dialysis back to the belief that long or frequent HD at home achieves the best outcomes. Keywords Home . Haemodialysis . Pediatric . Quotidian
D. K. Hothi (*) : L. Stronach Nephrology Department, Great Ormond Street Hospital for Children Foundation Trust, Great Ormond Street, London WC1N 3JH, UK e-mail: [email protected] E. Harvey Division of Nephrology, Hospital for Sick Children, University of Toronto, Toronto, Canada
Introduction In 1854 Thomas Graham of Glasgow first presented the principles of solute transport across a semi-permeable membrane [1], but it was not until 1914 that Abel et al. developed and tested the first efficient dialysis system at Johns Hopkins University School of Medicine [2]. The first human haemodialysis (HD) was performed in a uraemic patient by Haas in 1924 at the University of Giessen in Germany [3], but the first to construct a working dialyser was Dr. Willem Kolff in the 1940s [4]. In 1945 he successfully treated a 67-year-old woman in uraemic coma who regained consciousness after 11 h of HD with Kolff’s dialyser. The original Kolff kidney was not very useful clinically, because it did not allow for removal of excess fluid. Dr. Nils Alwall’s modification of a canister-enclosed dialyser led to the application of negative pressure across the membrane, offering the first truly practical application of HD in 1946. Alwall was also the inventor of the arteriovenous (AV) shunt for dialysis, describing glass shunts in rabbits in 1948. However, it was Dr. Belding H. Scribner who, working with a surgeon, Dr. Wayne Quinton, truly revolutionised access care with the formation of the Teflon Quinton–Scribner shunt [5]. Home HD started in the early 1960s, internationally, with groups
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