Kidney Week 2025 Early Program - Home Dialysis: Expanding Access to Home Therapies in 2025 and Beyond-Prescribing Home Dialysis Therapies: A Case-based Approach for Peritoneal Dialysis and Home Hemodialysis Prescriptions

Prescribing Home Dialysis Therapies: A Case-based Approach for Peritoneal Dialysis and Home Hemodialysis Prescriptions

Video Transcription

Video Summary

The session transitions to case-based teaching on peritoneal dialysis (PD) and home hemodialysis (HHD) prescribing.<br /><br />In PD, Dr. Gupta presents two cases highlighting the importance of dwell/contact time and residual kidney function. “Mia,” on cycler PD for four years, develops rising BUN and fatigue as residual kidney function declines; short effective contact time (fill/drain reduces true dwell) and a dry day limit solute removal. Adding a long daytime dwell (“day dwell”) can markedly improve time-dependent clearance of urea (and sometimes phosphorus), though it may reduce ultrafiltration depending on membrane transport. “Jose,” with short overnight dwells, develops thirst and falling sodium due to “sodium sieving”: free water is removed early via aquaporins while sodium removal lags, so short dwells leave sodium behind and drive polydipsia. Extending dwell time improved symptoms. She emphasizes tailoring PD via dwell time, fill volume, number of exchanges, dextrose/icodextrin choice, diet, and maximizing diuretics to preserve urine output.<br /><br />In HHD, Dr. Alshami reviews how changing frequency, flow fraction, and ultrafiltration affects treatment time and weekly dialysis dose, recommending maintaining adequate weekly hours (often ≥15). He promotes more frequent/nocturnal schedules for better volume control, lower ultrafiltration rates, improved recovery time, phosphorus control, and sleep apnea symptoms. He discusses recirculation from reversing blood lines, alarm troubleshooting, anticoagulation strategies, and the safety framework for solo HHD (requirements, monitoring, and bleeding-risk mitigation with moisture/blood detectors).

Asset Subtitle

Osama El Shamy, Nupur Gupta, Jenny I. Shen

Meta Tag

Module DIAL

Speaker FACULTY FACULTY

Keywords

peritoneal dialysis prescribing

home hemodialysis prescribing

dwell time and contact time

residual kidney function decline

cycler PD day dwell

sodium sieving and polydipsia

ultrafiltration rate and volume control

nocturnal and frequent hemodialysis schedules

solo home hemodialysis safety monitoring