Ministry of Health

Dakahlia Medical diroctorate

New Mansoura General Hospital

Nephrology Department

Dr. Osama El Shahat

Consultant of Nephrology Dr. Wael Ramadan

Head of nephrology department

New Mansoura General Hospital

Resident of nephrology

New Mansoura General Hospital

HD initiation protocol

Emergency HDx After clinical and laboratory assessment of the patient, emergency

HDx is done in the following cases whatever it:

1) Severe volume overload (i.e pulmonary oedema or impending pulmonary oedema).

2) Severe uremia (i.e pericardial effusion, uremic encephalopathy, severe pleural effusion and/or platelet dysfunction).

3) Severe hyperkalemia (s. k 6 mmol/L)

4)Severe academia (pH7.15 or less)

Initiation of regular Hdx:

ESRD:

1. Uremic manifestations (anorexia, nausea, vomiting, pleural effusion and/or easy fatigability) with bl. Urea 200mg/dl or more.

2. Volume overload refractory to diuretics. 3. eGFR less than 15ml/min/1.73m2. 4. s.cr more than 8mg/dl (6mg/dl if diabetic).

AKI:

1. Uremic manifestations (anorexia, nausea, vomiting, pleural effusion and/or easy fatigability) with bl. Urea 200mg/dl or more.

2. Volume overload refractory to diuretics.