Table Of ContentOXFORD MEDICAL PUBLICATIONS
Oxford Handbook of
Dialysis
Published and forthcoming Oxford Handbooks
Oxford Handbook for the Foundation Oxford Handbook of General
Programme 4e Practice 4e
Oxford Handbook of Acute Oxford Handbook of Genetics
Medicine 3e Oxford Handbook of Genitourinary
Oxford Handbook of Anaesthesia 4e Medicine, HIV and AIDS 2e
Oxford Handbook of Applied Oxford Handbook of Geriatric
Dental Sciences Medicine 2e
Oxford Handbook of Cardiology 2e Oxford Handbook of Infectious
Oxford Handbook of Clinical Diseases and Microbiology
and Healthcare Research Oxford Handbook of Key Clinical
Oxford Handbook of Clinical Evidence
and Laboratory Investigation 3e Oxford Handbook of Medical
Oxford Handbook of Clinical Dermatology
Dentistry 6e Oxford Handbook of Medical Imaging
Oxford Handbook of Clinical Oxford Handbook of Medical
Diagnosis 3e Sciences 2e
Oxford Handbook of Clinical Oxford Handbook of Medical Statistics
Examination and Practical Skills 2e Oxford Handbook of Neonatology
Oxford Handbook of Clinical Oxford Handbook of Nephrology
Haematology 4e and Hypertension 2e
Oxford Handbook of Clinical Oxford Handbook of Neurology 2e
Immunology and Allergy 3e Oxford Handbook of Nutrition
Oxford Handbook of Clinical and Dietetics 2e
Medicine – Mini Edition 9e Oxford Handbook of Obstetrics
Oxford Handbook of Clinical and Gynaecology 3e
Medicine 9e Oxford Handbook of Occupational
Oxford Handbook of Clinical Pathology Health 2e
Oxford Handbook of Clinical Oxford Handbook of Oncology 3e
Pharmacy 2e Oxford Handbook of
Oxford Handbook of Clinical Ophthalmology 3e
Rehabilitation 2e Oxford Handbook of Oral
Oxford Handbook of Clinical and Maxillofacial Surgery
Specialties 9e Oxford Handbook of Orthopaedics
Oxford Handbook of Clinical and Trauma
Surgery 4e Oxford Handbook of Paediatrics 2e
Oxford Handbook of Complementary Oxford Handbook of Pain Management
Medicine Oxford Handbook of Palliative Care 2e
Oxford Handbook of Critical Care 3e Oxford Handbook of Practical
Oxford Handbook of Dental Drug Therapy 2e
Patient Care Oxford Handbook of Pre-Hospital Care
Oxford Handbook of Dialysis 4e Oxford Handbook of Psychiatry 3e
Oxford Handbook of Emergency Oxford Handbook of Public Health
Medicine 4e Practice 3e
Oxford Handbook of Endocrinology Oxford Handbook of Reproductive
and Diabetes 3e Medicine & Family Planning 2e
Oxford Handbook of ENT and Head Oxford Handbook of Respiratory
and Neck Surgery 2e Medicine 3e
Oxford Handbook of Epidemiology Oxford Handbook of Rheumatology 3e
for Clinicians Oxford Handbook of Sport and
Oxford Handbook of Expedition Exercise Medicine 2e
and Wilderness Medicine 2e Handbook of Surgical Consent
Oxford Handbook of Forensic Medicine Oxford Handbook of Tropical
Oxford Handbook of Gastroenterology & Medicine 4e
Hepatology 2e Oxford Handbook of Urology 3e
Oxford Handbook of
Dialysis
FOURTH EDITION
Jeremy Levy
Consultant Nephrologist
and Adjunct Professor of Medicine
Imperial College Healthcare NHS Trust, London, UK
Edwina Brown
Consultant Nephrologist
and Honorary Professor of Renal Medicine
Imperial College Healthcare NHS Trust,
London, UK
Anastasia Lawrence
Senior Renal Lecturer Practitioner
and Honorary Senior Lecturer
Imperial College Healthcare NHS Trust & Buckinghamshire
New University, London, UK
1
1
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© Oxford University Press 2016
The moral rights of the authors have been asserted
First Edition published in 2001
Second Edition published in 2004
Third Edition published in 2009
Fourth Edition published in 2016
Impression: 1
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ISBN 978–0–19–964476–6
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Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-to-date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
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otherwise stated, drug dosages and recommendations are for the non-pregnant
adult who is not breast-feeding
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v
Foreword
Dialysis is at the same time one of the most exciting aspects of the care
of kidney patients, yet to the beginner also the most mysterious and
daunting. Unfamiliar concepts, impressive technology, new jargon, expert
patients—all of these can make for anxious times for the young doctor,
nurse, or other health worker joining the multiprofessional team which
cares for people with end-stage renal disease.
This Oxford Handbook provides much solace for the beginner. It pro-
vides plenty of easily navigable practical advice across every aspect of
dialysis and its related challenges, with sufficient theoretical background
to make sense of the day-to-day clinical decision-making. And all in a true
handbook—both small enough and light enough to fit in most pockets.
Since I was a tyro nephrologist much has changed in the world of dialysis.
For one thing there are many more patients, and many are older and frailer.
There has been greater creativity in strategies to improve clinical outcomes
and increase independence for the hospital environment—frequent home
haemodialysis, and assisted peritoneal dialysis are just two examples. And
we need a proper understanding of the complex end-of-life issues which
arise for more patients on dialysis and their carers.
This new edition addresses these recent issues and many more with
advice which is both authoritative and practical, as well as refreshing all the
content familiar to the readers of earlier editions.
Although its authors are all from the UK, this book has global value, espe-
cially in the several parts of the world where the provision of dialysis has
been inadequate for many reasons, but is now rapidly expanding. When
there is such rapid expansion, the education and training needs of the local
clinical team in ensuring high-quality dialysis care, can easily outstrip locally
available resources. In such situations this Oxford Handbook will be an
invaluable pragmatic educational tool.
I wish this book had been available when I started out in nephrology. It
would have saved me many anxieties, and I am sure would have improved
the care I was able to give.
John Feehally
University of Leicester, UK
vii
Preface
Welcome to the fourth, completely updated, edition of the Oxford
Handbook of Dialysis, which we hope you will find useful. It has been 7 years
since the last edition, and amazingly 15 years since the first edition, and
in that time there have been many developments in dialysis and in treat-
ing patients with end-stage kidney disease. We now have much better evi-
dence for various interventions (although renal medicine remains relatively
poorer at generating high-quality evidence than other areas of medicine),
and for the first time now some good trial data to support choices in treat-
ing patients, ranging from managing their anaemia or bone disease through
to haemodialysis strategies.
We have therefore updated every section of the book which now covers
all haemodialysis techniques, haemodiafiltration, nocturnal and home dialy-
sis, frequent dialysis, peritoneal dialysis in all its forms, plasma exchange,
the medical, nursing, and psychosocial aspects of managing patients with
end-stage kidney disease, nutrition, the acute management of renal trans-
plantation particularly with reference to dialysis patients, palliative and
end-of-life care in renal disease and use of analgesics, a completely new
section on renal replacement therapy in acute kidney injury, updated drug
dosing guidelines including new drugs, and summaries of the most recent
guidelines from Europe (European Best Practice Guidelines), the UK Renal
Association, the USA (KDOQI and KDIGO) and Australasia. Bone disease,
anaemia, cardiovascular disease, infections, pain, and the widespread com-
plications of chronic kidney disease are all discussed, with practical guidance
and management, presented in a compact and easy-to-use format.
We have added new sections on home haemodialysis, frequent haemo-
dialysis, new intradialytic monitoring techniques, new peritoneal dialysis
fluids, encapsulating peritoneal sclerosis, sleep disorders, management of
patients with stroke, care of dying patients with kidney disease or on dialy-
sis, and a new section on acute kidney injury. New drugs such as the new
epoetins and phosphate binders are included. We have ensured that the
sections on nursing and nutrition for dialysis patients have been written by
the appropriate experts, experienced renal nurses and dieticians respec-
tively, and both completely refreshed and updated.
We hope we ensured the book remains easy to use and read, which has
always been one of our primary aims, but also comprehensive, focussed,
and practical, and clearly aimed at the whole multiprofessional team of col-
leagues looking after patients on dialysis. We hope this book will have a
home in every renal unit, dialysis centre, intensive care unit, renal ward,
and be close to hand for every nephrologist, intensivist, renal trainee, renal
nurse, dietician, technician, and pharmacist, and that it helps improve the
care of patients with kidney disease.
ix
Contents
Contributors xi
Symbols and abbreviations xiii
1 The new patient with renal failure 1
2 Haemodialysis 71
3 Nursing a patient on haemodialysis 195
4 Home and frequent haemodialysis 237
5 Peritoneal dialysis 253
6 Nursing issues in peritoneal dialysis 353
7 Renal replacement therapy in acute kidney injury 365
8 Nutrition on dialysis 393
9 Special situations 415
10 Complications of ESKD: anaemia 457
11 Complications of ESKD: bone mineral disorders 481
12 Complications of ESKD: cardiovascular disease 513
13 Complications of ESKD: infection 529
14 Symptoms related to ESKD 539
15 Other complications of ESKD 559
16 Death in dialysis patients 591
17 Transplantation for dialysis patients 611
18 Drug dosing 621
19 Standards and guidelines 651
Index 659
