hd initiation protocol
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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.