Abstract
The role of medical director of a hemodialysis unit has become increasingly complex. Among the many roles it encompasses, the delivery of safe and effective dialysis treatments requires constant review, synthesis, and interpretation of the medical literature. Despite decades of experience with hemodialysis, the evidence base for dialysate prescription is relatively limited, with the choice of dialysate sodium being a prime example. The ask of this exercise was to imagine ourselves as the medical director of a new hemodialysis unit and to consider factors influencing the choice of dialysate sodium. While fiscal considerations are indeed important, one hopes that these align with the delivery of clinical care to improve patient well-being. Therefore, my approach was to focus on exploring the clinical responsibilities of a medical director in the choice of dialysate sodium. As such, after reviewing the evidence to date, my ‘default’ dialysate sodium prescription would be 140 mmol/L, but I would retain the option of individualizing treatment for certain patients until further evidence becomes available.
Highlights
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations
Central to the initial Conditions for Coverage (CfC) was the requirement that every unit have a medical director, whose responsibilities included development and implementation of facility policies and procedures, patient education, staff training and oversight, and the delivery of safe and effective dialysis treatments [2]
Use of higher dialysate sodium came with potential downsides, including thirst, inter-dialytic weight gain, and potentially higher average blood pressure [4,6]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Central to the initial CfC was the requirement that every unit have a medical director, whose responsibilities included development and implementation of facility policies and procedures, patient education, staff training and oversight, and the delivery of safe and effective dialysis treatments [2]. A huge responsibility comes with the position of medical director, especially with respect to the oversight of safe and effective dialysis delivery.
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