Handbook of Dialysis Therapy, 4th Edition

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1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 HANDBOOK OF DIALYSIS THERAPY, 4th EDITION

ISBN: 978-1-4160-4197-9

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, PA, USA: phone: (+1) 215 239 3804, fax: (+1) 215 239 3805, e-mail: [email protected]. You may also complete your request online via the Elsevier homepage (http://www.elsevier.com) by selecting Customer Support and then Obtaining Permissions. Notice Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Editors assumes any liability for any injury and/or damage to persons or property arising out or related to any use of the material contained in this book. The Publisher Previous editions copyrighted 2002 Library of Congress Cataloging-in-Publication Data Handbook of dialysis therapy/edited by Allen R. Nissenson, Richard N. Fine. – 4th ed. p. ; cm. Rev. ed. of: Dialysis therapy/[edited by] Allen R. Nissenson, Richard N. Fine. 3rd ed. c2002. Includes bibliographical references and index. ISBN 978-1-4160-4197-9 1. Hemodialysis. I. Nissenson, Allen R. II. Fine, Richard N. III. Dialysis therapy. [DNLM: 1. Renal Dialysis WJ 378 H236 2008] RC901.7.H45D527 2008 617.4„61059–dc22 2007024577 Acquisitions Editor: Susan Pioli Editorial Assistant: Joan Ryan Senior Project Manager: David Saltzberg Design Direction: Karen O’Keefe Owens Printed in China Last digit is the print number:

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This book is dedicated to the memory of Hinda Rosenthal, whose compassion, intelligence, wit, and wise advice had been an invaluable inspiration to me professionally and personally. Allen R. Nissenson, M.D. I would like to dedicate this Edition of Dialysis Therapy to my dear friend and colleague, John E. Lewy, MD, whose untimely death as he approached his 72nd Birthday was a tragic loss to the entire Pediatric Nephrology community. John was a pioneer in the field of Pediatric Nephrology and his friendship and wisdom will be forever missed. Richard N. Fine, M.D.

C O N T R I B U T O R S Sergio R. Acchiardo, M.D. Professor and Chief, Division of Nephrology, The University of Tennessee Health Science Center, Memphis, Tennessee Rajiv Agarwal, MBBS, MD, DNB, FAHA, FASN Professor of Medicine, Division of Nephrology, Indiana University; Staff Physician, Department of Medicine, VA Medical Center, Indianapolis, Indiana Amira Al-Uzri, MD, MCR Associate Professor of Pediatrics, Oregon Health & Science University, Portland, Oregon Connie Anderson, BSN, MBA Director of Clinical Services, Northwest Kidney Centers, Seattle, Washington Vincent T. Armenti, MD, PhD Professor of Surgery, Temple University School of Medicine; Interim Surgical Director, Kidney Transplantation, Temple University Hospital, Philadelphia, Pennsylvania Stephen R. Ash, MD, FACP Clinical Associate Professor, Indiana University Medical Center, Indianapolis; Director of Dialysis, Department of Nephrology, Arnett-Clarian Health System, Lafayette; Chairman and Director of Research and Development, HemoCleanse, Inc. and Ash Access Technologies, Inc., Lafayette, Indiana Morrell Michael Avram, MD Division of Nephrology, Long Island College Hospital, Brooklyn, New York Antonio Bellasi, MD Division of Nephrology, University of Milan and San Paolo Hospital, Milan, Italy

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Contributors

Mark R. Benfield, MD Professor of Pediatrics, University of Alabama at Birmingham; Professor and Division Director of Pediatric Nephrology, Children’s Hospital, Birmingham, Alabama William M. Bennett, MD Division of Nephrology, Legacy Good Samaritan Hospital, Portland, Oregon Jeffrey S. Berns, MD Associate Professor of Medicine, Renal, Electrolyte, and Hypertension Division, University of Pennsylvania School of Medicine; Penn Presbyterian Medical Center, Philadelphia, Pennsylvania Anatole Besarab, MD Clinical Professor of Medicine, Wayne State University School of Medicine; Director of Clinical Research, Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan Christopher R. Blagg, MD, FRCP Professor Emeritus of Medicine, University of Washington; Executive Director Emeritus, Northwest Kidney Centers, Seattle, Washington Geoffrey A. Block, MD Director of Clinical Research, Denver Nephrologists, PC, Denver, Colorado Paola Boccardo, BiolSciD Negri Bergamo Laboratories, Mario Negri Institute for Pharmacological Research, Bergamo, Italy W. Kline Bolton, MD Professor of Medicine and Chief of Nephrology, University of Virginia School of Medicine, Charlottesville, Virginia Mary L. Brandt, MD Professor and Vice Chair, Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Department of Pediatric Surgery, Texas Children’s Hospital, Houston, Texas

Contributors

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Eileen D. Brewer, MD Professor and Head, Renal Section, Department of Pediatrics, Baylor College of Medicine; Chief, Renal Service, Texas Children’s Hospital, Houston, Texas Patrick D. Brophy, MD Assistant Professor of Pediatrics (Pediatric Nephrology), University of Michigan; Department of Pediatrics and Communicable Diseases, CS Mott Children’s Hospital, Ann Arbor, Michigan Warren S. Brown, PhD Professor of Psychology and Director of the Travis Research Institute, Graduate School of Psychology, Fuller Theological Seminary, Pasadena, California Suphamai Bunnapradist, MD Division of Nephrology, Maggiore Hospital, IRCCS, Milan, Italy John M. Burkart, MD Professor of Internal Medicine, Division of Nephrology and Director, Dialysis Units, Wake Forest University Medical Center, Winston-Salem, North Carolina Vito M. Campese, MD Department of Medicine, The New York University School of Medicine; North Shore University Hospital, Manhasset, New York Ralph J. Caruana, MD Professor of Medicine, Division of Nephrology, Hypertension and Transplantation, Medical College of Georgia, Augusta, Georgia Darrell L. Cass, MD Assistant Professor, Michael E. DeBakey Department of Surgery and Department of Pediatrics, Baylor College of Medicine; Co-Director, Texas Children’s Fetal Center, Texas Children’s Hospital, Houston, Texas

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Contributors

Vimal Chadha, MD Assistant Professor of Pediatrics and Chief, Pediatric Nephrology, Virginia Commonwealth University Medical Center, Richmond, Virgina Christopher T. Chan, MD, FRCPC Assistant Professor of Medicine, University of Toronto; Medical Director, Home Hemodialysis, Toronto General Hospital, Toronto, Ontario, Canada Chaim Charytan, MD Clinical Professor of Medicine, Cornell University College of Medicine, New York; Chief, Renal Division, New York Hospital Medical Center of Queens, Flushing, New York William R. Clark, M.D. Clinical Assistant Professor of Medicine, Nephrology Division, Indiana University School of Medicine, Indianapolis, Indiana; Vice President, Medical Strategy and Therapy Development, Gambro, Inc., Lakewood, Colorado Allan J. Collins, MD, FACP Chronic Disease Research Group, Minneapolis, Minnesota Carl H. Cramer II, MD Lecturer, Department of Pediatric and Adolescent Medicine, Division of Pediatric Nephrology, Mayo Clinic, Rochester Terri L. Crawford-Bonadio, RN, CNN Director of Professional Education, Fresenius Medical Care North America, Lexington, Massachusetts Declan de Freitas, MB, BAO, BCh, LRCP&SI, MRCPI Registrar in Renal Medicine, Manchester Institute of Nephrology and Transplantation, The Royal Infirmary, Manchester, United Kingdom José A. Diaz-Buxo, MD, FACP Clinical Professor of Medicine, University of North Carolina, Chapel Hill, North Carolina; Senior Vice President, Home Therapies Development, Fresenius Medical Care North America, Lexington, Massachusetts

Contributors

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Lesley C. Dinwiddie, MSN, RN FNP, CNN Senior Vice President, Institute for Clinical Excellence, Education, and Research, Wheaton, Illinois Eileen N. Ellis, MD Professor of Pediatrics, University of Arkansas for Medical Sciences; Director, Pediatric Nephrology, Arkansas Children’s Hospital, Little Rock, Arkansas Janet A. Englund, MD Associate Professor of Pediatrics, University of Washington; Associate Professor of Pediatrics, Section of Infectious Diseases, Children’s Hospital and Regional Medical Center; Clinical Associate, Department of Infection Diseases, Fred Hutchinson Cancer Research Center, Seattle, Washington Fabrizio Fabrizi, MD Staff Nephrologist, Maggiore Hospital, IRCCS, Milan, Italy Donald A. Feinfeld, MD, FASN Professor of Clinical Medicine, Albert Einstein College of Medicine, Bronx; Nephrology Fellowship Program Director, Beth Israel Medical Center, New York, New York Charles Jerome Foulks, MD Professor of Medicine and Director, Division of NephrologyHypertension, Texas A&M University Health Science Center and College of Medicine, Scott & White Clinic and Hospital, Temple, Texas Denis Fouque, MD, PhD Professor of Nephrology, JE 2411-University Claude Bernard, Hôpital E. Herriot, Lyon, France Miriam Galbusera, BiolSciD Negri Bergamo Laboratories, Mario Negri Institute for Pharmacological Research, Bergamo, Italy Dayong Gao, PhD Professor of Mechanical Engineering, University of Washington, Seattle, Washington; Professor of Mechanical Engineering, University of Kentucky, Lexington, Kentucky

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Contributors

F. John Gennari, MD Robert F. and Genevieve B. Patrick Professor of Medicine, University of Vermont College of Medicine; Attending Physician, Department of Medicine, Fletcher Allen Health Care, Burlington, Vermont Jeffrey Giullian, MD Clinical Fellow, Division of Nephrology, Vanderbilt University, Nashville, Tennessee Stuart L. Goldstein, MD Associate Professor of Pediatrics, Baylor College of Medicine; Medical Director, Renal Dialysis Unit and Pheresis Service, Texas Children’s Hospital, Houston, Texas Esther A. Gonzalez, MD Associate Professor of Internal Medicine, Division of Nephrology, Saint Louis University, St. Louis, Missouri William G. Goodman, MD Professor of Nephrology, University of California, Los Angeles, California Frank A. Gotch, MD Associate Clinical Professor of Medicine, Division of Nephrology, University of San Francisco, San Francisco, California Leila Haghighat Research Assistant, Division of Nephrology, Stroger Hospital of Cook County, Chicago, Illinois Nikolas B. Harbord, MD Nephrology Fellow, Beth Israel Medical Center, New York, New York Elizabeth Harvey, MD, FRCPC Associate Professor of Pediatrics, University of Toronto; Division of Nephrology, Hospital for Sick Children, Toronto, Ontario, Canada

Contributors

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Nicholas Andrew Hoenich, PhD Lecturer in Clinical Science, School of Clinical Medical Sciences, Newcastle University; Clinical Scientist, Renal Unit, The Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom Christer Holmberg, MD Professor of Pediatrics, University of Helsinki; Head of Pediatric Nephrology and Transplantation, Hospital for Children and Adolescents, Helsinki, Finland Clifford J. Holmes, PhD Vice President, Scientific Affairs, Renal Division, Baxter Healthcare, McGaw Park, Illinois Robert Hootkins, MD, PhD, FASN Section Chief, Department of Nephrology and Hypertension, Austin Diagnostic Clinic, Austin, Texas Daljit K. Hothi, MBBS, MRCPCH Department of Pediatric Nephrology, Hospital for Sick Children, Toronto, Ontario, Canada Susan Hou, MD Professor of Medicine, Division of Nephrology. Loyola University Stritch School of Medicine, Chicago, Illinois Alastair J. Hutchison, MBChB, FRCP, MD Honorary Lecturer in Medicine, Manchester University Medical School; Clinical Director and Consultant in Renal Medicine, Renal Unit, Manchester Institute of Nephrology and Transplantation, Manchester, United Kingdom Zhongping Huang, PhD Assistant Professor of Mechanical Engineering, Widener University, Chester, Pennsylvania Todd S. Ing, MD Professor Emeritus of Medicine, Loyola University Chicago, Stritch School of Medicine, Maywood; Staff Physician, Department of Medicine, Veterans Affairs Hospital, Hines, Illinois

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Contributors

Curtis A. Johnson, PharmD Professor Emeritus of Pharmacy and Medicine, University of Wisconsin-Madison, Madison, Wisconsin Kamyar Kalantar-Zadeh, MD, MPH, PhD Associate Professor of Medicine and Pediatrics, Division of Nephrology and Hypertension, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles; Director of Dialysis Expansion Program and Epidemiology, Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, Torrance, California André A. Kaplan, MD, FACP, FASN Professor of Medicine, Division of Nephrology, University of Connecticut Health Center; Medical Director, University of Connecticut Dialysis Center; Chief, Blood Purification, John Dempsey Hospital, Farmington, Connecticut Toros Kapoian, MD, FACP Associate Professor of Medicine, Division of Nephrology and Hypertension, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School; Medical Director, Kidney Center of New Jersey; Robert Wood Johnson University Hospital; Medical Director, Dialysis Clinic, Inc., North Brunswick, New Jersey Elaine M. Kaptein, MD, FACP Professor of Medicine, Division of Nephrology, University of Southern California; Division of Nephrology, LAC+USC Medical Center, Los Angeles, California Pranay Kathuria, MD Associate Professor of Medicine and Chief, Section of Nephrology, University of Oklahoma College of Medicine, Tulsa, Oklahoma Jeffrey L. Kaufman, MD, FACS Associate Professor of Surgery, Tufts University School of Medicine, Boston; Vascular Surgeon, Baystate Medical Center, Springfield, Massachusetts

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William F. Keane, MD Vice-President, External Medical and Scientific Affairs, Merck & Company, Inc., North Wales, Pennsylvania Ramesh Khanna, MD Professor of Medicine and Director, Division of Nephrology, University of Missouri- Columbia, Columbia, Missouri Neenoo Khosla, MD Assistant Professor of Nephrology, Northwestern University Feinberg School of Medicine, Chicago, Illinois Paul L. Kimmel, MD, FACP, FASN Professor of Medicine and Director, Division of Renal Diseases and Hypertension, George Washington University School of Medicine, Washington, DC Carl M. Kjellstrand, MD, PhD, FACP, FRCP(C) Clinical Professor of Medicine, Loyola University, Chicago; Vice President, Medical Affairs, Aksys Ltd., Lincolnshire, Illinois Laura Kooienga, MD Assistant Professor, Division of Renal Diseases and Hypertension, University of Colorado Health Science Center, Denver, Colorado Peter Kotanko, MD Krankenhuas der Barmherzigen Brueder, Abteilung Innere Medizin, Graz, Austria Eugene C. Kovalik, MD, CM, FRCPCCS, FACP Associate Professor of Medicine, Division of Nephrology, Duke University Medical Center, Durham, North Carolina Matthias Kraemer, MD Scientific and Medical Affairs, Fresenius Biotech GmbH, Bad Homburg, Germany Anthony Langone, MD Assistant Professor of Medicine, Division of Nephrology, Vanderbilt University; Medical Director, Kidney Transplantation, Veterans Affairs Hospital, Nashville, Tennessee

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Contributors

Peter F. Lawrence, MD Professor of Surgery, Chief of Vascular Surgery, and Director of the Gonda Vascular Center, David Geffen School of Medicine, University of California, Los Angeles; University of California, Los Angeles, Center for Health Sciences, Los Angeles, California Jeffrey J. Letteri, BS Gambro, Inc., Lakewood, Colorado Chi-Bon Leung, MB, FRCP Senior Medical Officer, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Adeera Levin, MD, FRCPC Professor of Medicine, Division of Nephrology, University of British Columbia; Division of Nephrology, St. Paul’s Hospital; Director, BC Provincial Renal Agency, Vancouver, British Columbia, Canada Nathan W. Levin, MD Professor of Clinical Medicine, Albert Einstein College of Medicine; Attending Physician, Beth Israel Medical Center; Medical and Research Director, Renal Research Institute, New York, New York John Kenneth Leypoldt, PhD Research Professor of Medicine and Adjunct Professor of Bioengineering, Department of Medicine, University of Utah; Research Service, VA Salt Lake City Health Care System, Salt Lake City, Utah Philip Kam-Tao Li, MD, FRCP, FACP Professor and Chief of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Robert McGregor Lindsay, MD, FRCPC, FRCP(Edin), FACP, FRCP(Glasg) Professor of Medicine, Division of Nephrology, The University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada

Contributors

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Francisco Llach, MD Professor and Director of Clinical Nephrology, Georgetown University Medical Center, Washington, D.C. Margaret MacDougall, MD, PhD Clinical Associate Professor of Medicine, SUNY Upstate Medical University, Syracuse, New York Lionel U. Mailloux, MD, FACP Associate Professor of Medicine, New York University School of Medicine; Senior Attending Physician, Department of Medicine, North Shore University Hospital, Manhasset; Attending Physician, Division of Nephrology, St. Francis Hospital and Heart Center, Roslyn, New York Kevin J. Martin, MB, BCh, FACP Professor of Internal Medicine and Director, Division of Nephrology, Saint Louis University, St. Louis, Missouri Paul Martin, MD Professor of Medicine and Associate Director, Division of Liver Diseases, Mount Sinai School of Medicine, New York, New York Ziad A. Massy, MD, PhD Professor of Pharmacology and Director, INSERM ERT 12, University of Picardie; Professor of Clinical Pharmacology and Nephrology, Amiens University Hospital, Amiens, France Philip A. McFarlane, MD, PhD, FRCP(C) Professor, Division of Nephrology, University of Toronto; Medical Director, Home Dialysis, St. Michael’s Hospital, Toronto, Ontario, Canada Rajnish Mehrotra, MD, FACP, FASN Associate Professor of Medicine, David Geffen School of Medicine, University of California, Los Angeles; Director, Peritoneal Dialysis, Department of Medicine, Harbor-UCLA Medical Center; Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California

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Contributors

Mark M. Mitsnefes, MD, MS Associate Professor of Pediatrics, University of Cincinnati; Pediatric Nephrology, Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio Neal Mittman, MD Division of Nephrology, Long Island College Hospital, Brooklyn, New York Michael J. Moritz, MD Chief, Section of Transplantation, Lehigh Valley Hospital, Allentown, Pennsylvania Laura L. Mulloy, DO Professor of Medicine and Section Chief of Nephrology, Hypertension and Transplantation Medicine, Medical College of Georgia, Augusta, Georgia Sean W. Murphy, MD Associate Professor of Medicine, Divisions of Nephrology and Clinical Epidemiology, The Health Sciences Centre, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada Dana Negoi, MD Assistant Professor of Clinical Medicine and Medical Director, Medicine Specialty Clinic, University of Missouri, Columbia, Missouri Alicia M. Neu, MD Associate Professor of Pediatrics, The Johns Hopkins University School of Medicine; Medical Director, Pediatric Dialysis and Kidney Transplantation, Department of Pediatric Nephrology, The Johns Hopkins Hospital, Baltimore, Maryland Bijan Nikakhtar, MD Division of Nephrology, Georgetown University Medical Center, Washington, D.C.

Contributors

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Allen R. Nissenson, MD, FACP Professor of Medicine, Associate Dean, Director, Dialysis Program, and Attending Physician, Department of Medicine, University of California, Los Angeles, Medical Center, Los Angeles, California Pouneh Nouri, MD Division of Nephrology, Georgetown University Medical Center, Washington, D.C. Jed G. Nuchtern, MD Associate Professor, Michael E. DeBakey Department of Surgery and Department of Pediatrics, Baylor College of Medicine, Houston, Texas Matthew J. Oliver, MD Division of Nephrology, Medical College of Georgia, Augusta, Georgia Ali J. Olyaei, PharmD, BCPS Associate Professor of Medicine, Division of Nephrology and Director, Clinical Trials, Oregon Health and Science University, Portland, Oregon Madeleine V. Pahl, MD, FACP Associate Professor of Medicine, Division of Nephrology, University of California, Irvine; Director of Renal Clinic, Division of Nephrology, University of California, Irvine, Medical Center, Orange, California Patricia Painter, PhD Associate Professor of Medicine, Division of Renal Medicine, University of Minnesota, Minneapolis, Minnesota Biff F. Palmer, MD Professor of Internal Medicine and Director, Renal Fellowship Training Program, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas Patrick S. Parfrey, MD, FRCPC University Research Professor, Department of Medicine, Memorial University; Staff Nephrologist, Eastern Health, St. John’s, Newfoundland, Canada

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Contributors

Ashley A. Perilloux, MS, RD Pediatric Renal Dietitian, University of California, Los Angeles/DaVita Pediatric Dialysis, Los Angeles, California Phuong-Chi T. Pham, MD Associate Clinical Professor of Medicine, Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles; Division of Nephrology, Olive View-UCLA Medical Center, Sylmar, California Phuong-Thu T. Pham, MD Assistant Clinical Professor of Medicine, Kidney and Pancreas Transplantation, David Geffen School of Medicine, University of California, Los Angeles, California Andreas Pierratos, MD, FRCPC Associate Professor of Medicine, University of Toronto; Head, Home Hemodialysis, Department of Medicine, Humber River Regional Hospital, Toronto, Ontario, Canada Joanne D. Pittard, MS, RN Professor of Allied Health, Community Services Education, Glendale Community College, Santa Monica, California Patrick H. Pun, MD Fellow in Nephrology, Duke University Medical Center, Durham, North Carolina Erik Qvist, MD, PhD Professor, University of Helsinki; Pediatric Nephrology and Transplantation, Hospital for Children and Adolescents, Helsinki, Finland Dominic S.C. Raj, MD, DM Associate Professor of Medicine, Division of Nephrology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico Giuseppe Remuzzi, MD, FRCP Director, Division of Nephrology and Dialysis, Azienda Ospedaliera Ospedali Riuniti di Bergamo; Research Coordinator, Negri Bergamo Laboratories, Mario Negri Institute for Pharmacological Research, Bergamo, Italy

Contributors

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Claudio Rigatto, MD, FRCPC, MACP, MSc Assistant Professor of Medicine, University of Manitoba; Staff Nephrologist, Manitoba Renal Program, Winnipeg, Manitoba, Canada Michael V. Rocco, MD, MSCE, FACP Professor of Internal Medicine (Nephrology), Wake Forest University School of Medicine; Division of Nephrology, North Carolina Baptist Hospital, Winston-Salem, North Carolina Rudolph A. Rodriguez, MD Associate Professor of Medicine, Division of Nephrology, University of Washington; Section Head, Primary and Specialty Medicine Service Line, VA/Puget Sound Medical Center, Seattle, Washington Claudio Ronco, MD Director, Department of Nephrology, Dialysis, and Transplantation, St. Bortolo Hospital, Vicenza, Italy Kai Rönnholm, MD, PhD Professor, University of Helsinki; Pediatric Nephrology and Transplantation, Hospital for Children and Adolescents, Helsinki, Finland Mitchell H. Rosner, MD Assistant Professor of Medicine and Associate Chief for Faculty Development, Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia John H. Sadler, MD Associate Professor Emeritus of Medicine, Division of Nephrology, University of Maryland; President and Chief Medical Officer, Independent Dialysis Foundation, Baltimore, Maryland Isidro B. Salusky, MD Professor of Pediatrics, Associate Dean of Clinical Research, Director, Pediatric Dialysis Program, Director, General Clinical Research Center, David Geffen School of Medicine, University of California, Los Angeles, California

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Contributors

Ramin Sam, MD Assistant Professor of Medicine, University of Illinois at Chicago Medical Center; Physician, Stroger Hospital of Cook County, Chicago, Illinois Cheryl P. Sanchez, MD Associate Professor of Pediatrics, University of Wisconsin School of Medicine and Public Health; Department of Pediatrics, University of Wisconsin Children’s Hospital, Madison, Wisconsin Scott G. Satko, MD Assistant Professor of Medicine and Director, Nephrology Fellowship Program, Division of Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina Franz Schaefer, MD Professor of Pediatrics, University of Heidelberg; Chief, Division of Pediatric Nephrology, Hospital for Pediatric and Adolescent Medicine, Heidelberg, Germany Rebecca J. Schmidt, DO, FACP, FASN Professor of Medicine and Chief, Section of Nephrology, West Virginia University School of Medicine; West Virginia University Hospitals, Morgantown, West Virginia Cornelis H. Schröder, MD, PhD Professor of Pediatric Nephrology, University Medical Center, Wilhelmina Children’s Hospital, Utrecht, The Netherlands Gerald Schulman, MD, FAAN Professor of Medicine, Director of Hemodialysis, Co-Director of Clinical Trials Center in Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee Steve J. Schwab, MD Department of Medicine, Division of Nephrology, Medical College of Georgia, Augusta, Georgia Michael H. Schwenk, PharmD Division of Nephrology and Hypertension, The New York Hospital of Queens, Flushing, New York

Contributors

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Warren B. Shapiro, MD Associate Professor of Clinical Medicine, State University of New York Health Sciences Center at Brooklyn; Co-Chief, Division of Nephrology and Hypertension, Brookdale University Hospital and Medical Center, Brooklyn, New York Richard A. Sherman, MD Professor of Medicine, Division of Nephrology, University of Medicine and Dentistry of New Jersey— Robert Wood Johnson School of Medicine, New Brunswick, New Jersey Jodi M. Smith, MD, MPH Assistant Professor of Pediatrics, University of Washington; Division of Nephrology, Children‘s Hospital and Regional Medical Center, Seattle, Washington Michael J.G. Somers, MD Assistant Professor of Pediatrics, Harvard Medical School; Director of Clinical Services, Division of Nephrology, Children’s Hospital Boston, Boston, Massachusetts Evelyn Spanner, MSc, RD Renal Program, London Health Sciences Centre, London, Ontario, Canada Bruce S. Spinowitz, MD, FACP Associate Clinical Professor of Medicine and Associate Chairman, Department of Medicine, New York Hospital of Queens, Flushing, New York John C. Stivelman, MD Associate Professor of Medicine, Division of Nephrology, University of Washington School of Medicine; Chief Medical Officer, Northwest Kidney Centers, Seattle, Washington Cheuk-Chun Szeto, MD, FRCP Professor, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong

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Contributors

Alf M. Tannenberg, MD Professor of Clinical Medicine, New York Medical College; Chief, Renal Service, Metropolitan Hospital Center, New York, New York Karen B. Tipton, RN, BSN, CPN Director, Renal Care Center, Children’s Hospital of Alabama, Birmingham, Alabama Avram Z. Traum, MD Harvard Medical School; Division of Nephrology, Children’s Hospital Boston, Boston, Massachusetts Arthur Tsai, MD Post-doctoral Fellow, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Zbylut J. Twardowski, MD, PhD Professor Emeritus of Medicine, Division of Nephrology, University of Missouri, Columbia, Missouri Antonios H. Tzamaloukas, M.D. Professor of Medicine, University of New Mexico School of Medicine; Chief, Renal Section, New Mexico Veterans Affairs Health Care System; Staff Nephrologist, University of New Mexico Hospital; Nephrologist, Dialysis Clinics, Inc., Albuquerque, New Mexico Raymond Vanholder, MD Department of Internal Medicine, Nephrology Section, University Hospital, Ghent, Belgium Nosratola D. Vaziri, MD, MACP Professor of Medicine, Physiology and Biophysics, Division of Nephrology, University of California, Irvine; Chief, Division of Nephrology and Hypertension, University of California, Irvine Medical Center, Orange, California Maureen Wakeen, RN, MS Department of Medicine, Division of Nephrology, University of Wisconsin and University of Wisconsin Hospital, Madison, Wisconsin

Contributors

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Bradley A. Warady, MD Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Associate Chairman, Department of Pediatrics, Chief, Section of Pediatric Nephrology, and Director, Dialysis and Transplantation, Children’s Mercy Hospital, Kansas City, Missouri Richard A. Ward, PhD Professor of Medicine, Division of Nephrology, Kidney Disease Program, University of Louisville, Louisville, Kentucky Steven J. Wassner, MD Vice-Chair for Education and Chief, Division of Pediatric Nephrology and Hypertension, Penn State University College of Medicine; Department of Pediatrics, The Penn State Children’s Hospital, The Milton S. Hershey Medical Center, Hershey, Pennsylvania Steven D. Weisbord, MD, MSc Assistant Professor of Medicine, Renal-Electrolyte Division, University of Pittsburgh School of Medicine; Staff Physician, Renal Section and Core Investigator, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania John J. White, MD Assistant Professor, Division of Nephrology, Medical College of Georgia, Augusta, Georgia Suzanne H. White, RN, CNP Nurse Clinician, Renal Care Center, Children’s Hospital of Alabama, Birmingham, Alabama James F. Winchester, MD Chief, Division of Nephrology, Beth Israel Medical Center, New York, New York David W. Windus, MD Professor of Medicine, Renal Division, Washington University School of Medicine; Attending Physician, Barnes-Jewish Hospital, St. Louis, Missouri

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Contributors

Jay B. Wish, MD Professor of Medicine, Case Western Reserve University; Medical Director, Hemodialysis Services, Division of Nephrology, University Hospitals Case Medical Center, Cleveland, Ohio Anthony R. Zappacosta, MD Director of Dialysis, Campus Chief, Nephrology, Department of Medicine, The Bryn Mawr Hospital, Bryn Mawr, Pennsylvania Stephen W. Zimmerman, MD Professor Emeritus, Department of Medicine, University of Wisconsin; Division of Nephrology, Saint Mary’s Hospital; Madison Area Renal Specialists, Madison, Wisconsin

P R E F A C E The dialysis population continues to grow both in the United States and worldwide. Emerging economies as well as developing nations have chosen to utilize resources to extend the lives of individuals afflicted with end-stage renal disease (ESRD). Despite assiduous efforts to utilize renal transplantation as a viable option for potential recipients with ESRD, the increments in the number of transplants performed annually have been modest and certainly have been woefully inadequate compared to the annual growth in the dialysis population. Any such increments in the number of renal transplants performed annually have resulted, at least in the United States, from the increased availability of living donors. Limited availability of deceased donor organs continues to impede successful renal transplantation worldwide. Consequently, patients require dialysis therapy for prolonged periods of time. This results in the development and/or progression of the consequences of uremia, and the associated co-morbid conditions: hypertension, cardiovascular disease, and those related to diabetes mellitus. The objective of the initial edition of Handbook of Dialysis Therapy was to enlist the involvement of preeminent individuals in various areas of clinical dialysis, to address, in a succinct fashion, the pertinent clinical problems encountered in adults and children undergoing dialysis. The intent was to provide a “howto” approach to help the potential reader to solve specific patient problems. Dialysis Therapy was developed to help nephrologists (pediatric and adults), nurses, technicians and other members of the health care team resolve the myriad of problems confronting the patients undergoing dialysis. It has been almost a decade since the 3rd Edition of Dialysis Therapy and the practice of dialysis continues to be modified to meet the increasing complexity of the patient population and the technical and pharmaceutical advances. Many of the contributors to this edition of Handbook of Dialysis Therapy have contributed to previous editions; however, there are 29 new contributors to the 4th Edition who have brought a new perspective to the clinical problems of dialysis encountered. Similarly, the format for this 4th edition has been updated from previous editions. In addition to adding new chapters, we have paid particular attention to the readability of the text, tables, and figures. Resizing of the book to make it more xli

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Preface

portable and the abundant use of color are additional enhancements. This book remains a problem solving tool and is complementary to our larger, more comprehensive textbook Clinical Dialysis, the 4th Edition, which was published in 2006. We wish to thank all of our contributors for their outstanding work and hope that this book will be a useful reference for physicians, nurses, technicians, dieticians, social workers and administrators, all of whom assiduously attempt to optimize the clinical care of the dialysis population. The Editors wish to thank Susan Pioli, from Elsevier, whose invaluable assistance made the publication of this text possible. Allen R. Nissenson, MD Richard N. Fine, MD Editors

Table of Contents

Section 1 DEMOGRAPHICS 1 Demographies, Allan Collins Section 2 VASOJLAR ACCESS FOR HEMOD IALYS IS 2 Temporary Vascular Access for Hemodialysis, John J. White, Matthew J. Oliver, and Steve]. Schwab 3 (valuation for Vascular Access Dysfunction, David Windus 4 Va~ular Access for Hemodialysis, Peter F. Lawrence

5 Major Complications !rom Vascular Acœs.s for Chronie Hemodialy!.is, Jeffrey L. Kau fman 6 Dialysis Access Reôrculation, Richard A. Sherman aoo Toros Kapoian

Section 3 PERITONEAL ACCESS DEVieES

7 Peritoneal Acœss Deviees and Placement Techniques, Stephen R. Ash 8 Compl ica tions of Acule Peritoneal Catheter Insertion, Anthony R. Zappacosta

Section 4 MECHANICAl ASPECTS Of OIALYSIS 9 Water Treatment Equipment for In-Center Hemodialysis: Includ ing Verification o f Water Quality and Oisinfection, Richard A. Wa rd 10 Single-Patient Hemodialysis Machines. Richard A. Ward 11 Single Needle Oialysis, Matthias Kraemer 11 Safety Monitors in Hemodialysis, Joanne O. Pittard 13 Methods of HemodialysisAnticoag ulat ion, Patrick H. Pun and Eugene C. Kovalik 14 Home Preparation and Instal lation for Home Hemod ialysis. Christopher R. Blagg and Connie Anderson 15 Per itoneal Dialysis Cyders and other Mechanical Deviees, Jose A. Oiaz-Buxo

Sectio n 5 DIALVZERS 16 Choosing the DialyserTechnical and Clinical Considerations, Nicholas A. Hoenich and Claudio Roneo 17 Biocompatibility of Dialysis Membranes. Nicho las A Hoenich and Oaudio Roneo

Section 6 KINETIC MODEUNG IN HEMODIALYSIS 18 Urea Kinetic Modeling to Guide Hemodialysis Therapy in Adults, Frank A. Gotch 19 Simpli fied Formu las and Nomograms for Monitoring Hemodialysis Adequacy, Richard A. Sherman and Robert Hootkins

Sectioro71MPROVING OUTCOMES IN DIALYSIS PATIENTS 20 Quality, Safety, and Acco untab ility, Jay B_Wish 21 Initiation of Dia lysis Therapy, Scott G. Satko and John M. Burkart 22 Oai ly Iquotidian) Hemodialys is, Andreas Pie rrato>, Chris Chan, and Phi l McFariane 23 NKF-KjOOQI (DOQI): Key Recommendations, Adee ra Levin and Mike Rocco Section 8 THE HEODIALYSIS PROCEDURE 24 Cannulation of Hemodialysis Vascular Access: Science and Art. Lesl ie C. Oinwidd ie 2S lsolated Ultrafiltrat io n, John J. White, Laura L. Mulloy, Ra lph J. Caruana, and Todd S. Ing Sectioro9 COMPUCATIONS DURING HEMOOIAlYSIS 26 Common Clin ical Problems during Hemodialysis, Peter Kotanko and Natha n W _Levin 27 Hemod ialysis ·Associate