Aplicación de una pauta de hemodiálisis incremental, basada en la función renal residual, al inicio del tratamiento renal sustitutivo

Merino, José Luis; Domínguez, Patricia; Bueno, Blanca; Amézquita, Yésika; Espejo, Beatriz; Paraíso, Vicente

doi:10.1016/j.nefro.2016.11.015

Cited by 13 publications

(12 citation statements)

References 27 publications

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“…In our center, the progression criteria from 1 to 2 sessions a week are based on the decrease in Kur <4 and >2.5 mL/min/1.73 m 2 ; weekly weight gain that entails ultrafiltration rates >13 mL/kg/h, maintained for 3 weeks; and any clinical event that requires unscheduled sessions (>1) for resolution such as hyperkalemia. In Spain, Merino et al [ 12 ], described their experience of the first 8 years of application of an iHD of 2 sessions a week and its impact on the maintenance of RKF. Out of 15 patients included with a follow-up of no <12 months in iHD, 6 patients required conversion at 3 HD/week due to laboratory parameters (hyperkalemia and high levels of phosphorus persistently) and 2 due to episodes of heart failure.…”

Section: Discussionmentioning

confidence: 99%

Patiromer in a Patient with Severe Hyperkalemia on Incremental Hemodialysis with 1 Session per Week: A Case Report and Literature Review

Merino

Deira

Marschall

et al. 2021

Case Rep Nephrol Dial

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Hyperkalemia is common in patients with ESRD, undergoing hemodialysis (HD), and is associated with an increase in hospitalization and mortality. Residual kidney function in long-term dialysis patients is associated with lower morbidity and mortality in HD patients. Although the 2015 National Kidney Foundation-Kidney Disease Outcomes Quality Initiate (NKD-KDOQI) guidelines allow the reduction in the weekly HD dose for patients with a residual kidney urea clearance (Kur) >3 mL/min/1.73 m<sup>2</sup>, very few centers adjust the dialysis dose based on these criteria. In our center, the pattern of incremental hemodialysis (iHD) with once-a-week schedule (1 HD/W) has been an option for a group of patients showing very good results. This pattern is maintained as long as residual diuresis is >1,000 mL/24 h, Kur is >4 mL/min, and there is no presence of edema or volume overload, as well as no analytical parameters persistently outside the advisable range (serum phosphorus >6 mg/dL or potassium [K<sup>+</sup>] >6.5 mmol/L). Management of hyperkalemia in HD patients includes reduction of dietary intake, dosing of medications that contribute to hyperkalemia, and use of cation-exchange resins such as calcium or sodium polystyrene sulfonate. Two newer potassium binders, patiromer sorbitex calcium and sodium zirconium cyclosilicate, have been safely used for potassium imbalance treatment in patients with ESRD in HD with a conventional regimen of thrice weekly, but has not yet been studied in 1 HD/W schedules. We present the case of a 76-year-old woman in iHD (1 HD/W) treated with patiromer for severe HK and describe her clinical characteristics and outcomes. In addition, we review the corresponding literature. Based on these data, it can be anticipated that the use of patiromer may overcome the risk of hyperkalemia in patients with incident ESRD treated with less-frequent HD regimens.

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Section: Discussionmentioning

confidence: 99%

Patiromer in a Patient with Severe Hyperkalemia on Incremental Hemodialysis with 1 Session per Week: A Case Report and Literature Review

Merino

Deira

Marschall

et al. 2021

Case Rep Nephrol Dial

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“…In this extreme balance, dialysis is intended as “renal replacement therapy” (RRT), a treatment that has to deliver, regardless of the residual renal function, full artificial depuration. While the definition of “adequate” and “optimal” dialysis is not clear, a strict “RRT approach” ignores residual renal function, in spite of the fact that its presence is one of the most important survival markers [ 18 , 25 – 27 , 87 – 89 ].…”

Section: Discussionmentioning

confidence: 99%

“…The slow progression of his chronic kidney disease, with good residual diuresis and lack of life-threatening episodes of ionic derangements (including hyperkalemia) further supported this approach [ 85 – 89 ].…”

Section: The Principlist Approachmentioning

confidence: 99%

The strange case of Mr. H. Starting dialysis at 90 years of age: clinical choices impact on ethical decisions

2017

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BackgroundStarting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at “extreme” ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions.Case presentationMr. H is a ninety-year-old patient with end-stage kidney disease that is no longer manageable with conservative care, in spite of optimal nutritional management, good blood pressure control and strict clinical and metabolic evaluations; dialysis is the next step, but its morbidity is challenging. The case is analysed according to principlism (beneficence, non-maleficence, justice and respect for autonomy).In the setting of care, dialysis is available without restriction; therefore the principle of justice only partially applied, in the absence of restraints on health-care expenditure. The final decision on whether or not to start dialysis rested with Mr. H (respect for autonomy). However, his choice depended on the balance between beneficence and non-maleficence. The advantages of dialysis in restoring metabolic equilibrium were clear, and the expected negative effects of dialysis were therefore decisive. Mr. H has a contraindication to peritoneal dialysis (severe arthritis impairing self-performance) and felt performing it with nursing help would be intrusive. Post dialysis fatigue, poor tolerance, hypotension and intrusiveness in daily life of haemodialysis patients are closely linked to the classic thrice-weekly, four-hour schedule. A personalized incremental dialysis approach, starting with one session per week, adapting the timing to the patient’s daily life, can limit side effects and “dialysis shock”.ConclusionsAn individualized approach to complex decisions such as dialysis start can alter the delicate benefit/side-effect balance, ultimately affecting the patient’s choice, and points to a narrative, tailor-made approach as an alternative to therapeutic nihilism, in very old and fragile patients.

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“…Volume overload or edema closely linked with other clinical instability [20]. Therefore, patients with evidence of edema were excluded in the current study and in previous studies [21–23].…”

Section: Methodsmentioning

confidence: 99%

Insulin Resistance and Cardiovascular Risks in Different Groups of Hemodialysis Patients: A Multicenter Study

Duong

Shih

Wong

et al. 2019

BioMed Research International

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Background. To investigate the association between insulin resistance (IR) and cardiovascular disease (CVD) risks among hemodialysis patients. Methods. We conducted a cross-sectional study between 2013 and 2017, on 384 hemodialysis patients from seven hospital-based-dialysis centers. HOMA-IR is classified according to median value. The CVD risks were defined by the K/DOQI Guidelines. Logistic regression analysis was used. Results. Patients’ age was 60.9 ± 11.8, 58.1% men, and 40.3% overweight/obese. The median of HOMA-IR was 5.4, 82.8% high systolic blood pressure, and 85.7% hyperhomocysteinemia. In multivariate analysis, IR was significantly associated with higher odds of low high-density lipoprotein cholesterol, high triglyceride, and impaired fasting glucose in groups of normal weight, overweight/obese, nondiabetes, diabetes, and overall sample. IR linked with elevated high-sensitive C-reactive protein in normal weight patients (odd ratio, OR=2.21, 95% confidence interval, 1.16-4.22, p < .05), with hypoalbuminemia in normal weight patients (OR=8.31, 95% CI, 2.35-29.37, p < .01), in nondiabetes patients (OR=6.59, 95% CI, 1.81-23.95, p < .01), and overall sample (OR=3.07, 1.51-6.23, p < .01). Conclusions. The level of IR and prevalence of CVD risks were high in hemodialysis patients. IR was independently associated with CVD risks.

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Aplicación de una pauta de hemodiálisis incremental, basada en la función renal residual, al inicio del tratamiento renal sustitutivo

Cited by 13 publications

References 27 publications

Patiromer in a Patient with Severe Hyperkalemia on Incremental Hemodialysis with 1 Session per Week: A Case Report and Literature Review

Patiromer in a Patient with Severe Hyperkalemia on Incremental Hemodialysis with 1 Session per Week: A Case Report and Literature Review

The strange case of Mr. H. Starting dialysis at 90 years of age: clinical choices impact on ethical decisions

Insulin Resistance and Cardiovascular Risks in Different Groups of Hemodialysis Patients: A Multicenter Study

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