Dialysis

Question 1

2 oral OHG agents that could be potentially be used in haemodialysis patients or PD patients?

Answer 1

1. Glipizide (2.5mg OD) - sulfonylurea
2. Repaglinide - insulin secretagogue

But Insulin is usually a preferred agent

Question 2

How would you approach recommending home HD for this patient?

Answer 2

If the patient has a reasonable health literacy and no significant physical impairment (e.g. eyesight, hand function, mobility) - reasonable to recommend it.

1. Advantages: much more flexible. You can do it in your own time to fit around your life (even at night). Don’t need to live around scheduled HD at the hospital. improved survival - particularly for longer and more frequent dialysis
2. Reassure patient: a common reason for declining home HD is fear that they’d be abandoned by staff. Far from truth, they get intense education in the hospital for minimum of 2 weeks (cannulation, working the machines, heparin) and 2 weeks at home, followed by more over time until patient feels confident.