Figure 613

All these components are important as contributors to a successful dialysis prescription. The Dialysis Outcomes Quality Initiative (DOQI) recommendations should be followed to achieve an adequate dialysis prescription, and the time on dialysis should be monitored carefully. When the delivered dialysis dose is less that prescribed, the reversible factors listed in Figure 6-10 should be addressed first. Subsequently, an increase in blood flow to 400 mL/min should be attempted. Increases in dialyzer surface area and treatment time also may be attempted. In addition, attention should be paid to the correct dialysis composition and to the ultrafiltration rate to make certain that patients achieve a weight as close as possible to their dry weight. Hematocrit should be sustained at 33% to 36%. Finally, vitamin D supplementation to prevent secondary hyperparathyroidism and use of normal saline or other volume expanders are encouraged to treat hypotension during dialysis. KoA—constant indicating the efficiency of the dialyzer in removing urea.

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