Introduction

Haemodialysis is the most common form of renal replacement therapy. This involves regular filtration of the blood through a dialysis machine in hospital. Most patients need dialysis 3 times per week, with each session lasting 3-5 hours. At least 8 weeks before the commencement of treatment, the patient must undergo surgery to create an arteriovenous fistula, which provides the site for haemodialysis. Most commonly this is created in the lower arm. Some patients may be trained to perform home haemodialysis so that they do not have to regularly attend hospital.

Indications

The most common indication for haemodialysis is chronic kidney disease.

Haemodialysis is used in acute kidney injury if patients are not responding to medical treatment. Indications include:
  • hyperkalaemia
  • metabolic acidosis
  • complications of uraemia
  • pulmonary oedema


Overdose

Drugs that can be cleared with haemodialysis - mnemonic: BLAST
  • Barbiturate
  • Lithium
  • Alcohol (inc methanol, ethylene glycol)
  • Salicylates
  • Theophyllines (charcoal haemoperfusion is preferable)

Drugs which cannot be cleared with haemodialysis include
  • tricyclics
  • benzodiazepines
  • dextropropoxyphene (Co-proxamol)
  • digoxin
  • beta-blockers