CSN GuidelineCanadian Society of Nephrology Guidelines for the Management of Patients With ESRD Treated With Intensive Hemodialysis
Section snippets
Background
Longer and more frequent (“intensive”) hemodialysis has emerged as desirable alternative treatment strategies for patients with end-stage renal disease (ESRD). Although there is significant variability in prescription practices, 3 pragmatically defined categories encompass the majority of intensive dialysis prescriptions used in Canada and elsewhere: short daily (<3.0 hours, 5-7 days per week), long (often nocturnal; ≥5.5 hours, 3-4 sessions per week), and long-frequent (usually nocturnal; ≥5.5
Purpose of the Guidelines
Our objective was to develop a clinically useful guideline (summarized in Box 1) to assist physicians and allied health care practitioners in the management of patients with ESRD who have chosen more intensive hemodialysis as their treatment modality; it is not intended to replace clinical judgment.
Guideline Panel Composition
To form the guideline panel (Box 2), physicians with an established clinical interest in intensive hemodialysis prescriptions were identified with representation from across Canada. Many of these physicians also have a background in clinical investigation, research methods, guideline development, and knowledge translation.
Target Population and Interventions
Intensive hemodialysis was defined as any hemodialysis schedule that included an increase in frequency and/or an increase in session duration compared to conventional hemodialysis (ie, 3 times per week, 3-5 hours per session). Short daily hemodialysis was defined as 5 or more dialysis sessions per week with fewer than 3 hours per session. Long hemodialysis was defined as greater than or equal to 5.5 hours per session, 3-4 times per week, and long-frequent hemodialysis was defined as greater
Recommendation 1
Recommendation 1 is provided in Box 3.
Acknowledgements
Support: A grant was provided by the CSN to support this guideline development, and this work was funded in part by a Canadian Institutes of Health Research Meeting Planning and Dissemination Grant FRN # 106165.
Financial Disclosure: The authors declare that they have no relevant financial interests.
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Originally published online April 15, 2013.
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G.E.N., R.A.M., and D.L.Z. contributed equally to this work.