dialyzer size - pump speed - dialysate speed - max Ultrafiltration and the relation with sex - age - BMI and cardiac health
For sure you must adjust with patient situation, weight, blood pressure, and the increase weight between two dialysis.
There are some individual parameters which must be set for each particular patient (dialysis time, blood flow, heparin dose, sodium and bicarbonate concentration, substitution volume if you use HDF) or even for each dialysis session (volume to be ultrafiltered). There are a few "rules of thumb" with which you can start and later adjust according to the results:
Dialysis session time should not be less then 4 hours
Blood flow should be high enough to give total processed blood volume equal or higher than body weight
Sodium concentration about 3 mmol/l higher than patient predialysis plasma value
Bicarbonate concentration i dialysate - start with 30 mmol/l is safe.
UF rate should not generally exceed 10 ml/hour/kg of body weight
If you use unfractionated heparin you can start with bolus of 50 iu per kg of body weight and then 300 iu/hour as an infusion. This will certainly need adjustment - you have to look to bleeding time after removal of needles and to the dialyzer appearance (how many fibres are clotted) after rinse back.
Adding to the answer above:
Individualize time based on URR and Kt/V. Not muchof longer time but have it at least of 2.5 hr.
Blood flow can be from 300 to 500 ml.hr (based on european vs US ways and conditions of vascular access).
Also not all patients require same dose of Heparin.
Have a baseline set for patient for Na. Some patients are compliant w diet and sodium does not fall much between HD and some are not and drink a lot. Much high Na after HD can make them drink more and gain more weight.
Hi Ramin
Find attached link to helpful paper
http://onlinelibrary.wiley.com/doi/10.1111/tap.2015.19.issue-s1/issuetoc
Can you please elaborate a little more that exactly what you wants to know. This question is very vague and requires several text books to cover he answer.
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