Clinical Outcome of Twice-Weekly Hemodialysis Patients with Long-Term Dialysis Vintage

Abstract

Background/Aims: Twice-weekly hemodialysis(HD) is prevalent in the developing countries, scarce data are available for this treatment in patients with long-term dialysis vintage. Methods: 106 patients with more than 5 years HD vintage undergoing twice-weekly HD or thrice-weekly HD in a hemodialysis center in Shanghai between December 1, 2013 and December 31, 2013 were enrolled into the cohort study with 3 years follow-up. Kaplan–Meier analysis and Cox proportional hazards models were used to compare patient survival between the two groups. Subgroup analysis of 62 patients more than 10 years HD vintage was also performed according to their different dialysis frequency. Results: Compared with patients on thrice-weekly HD, twice-weekly HD patients had significantly longer HD session time and higher single-pool Kt/V (spKt/V) (session time, 4.59±0.45 vs 4.14±0.31 hours/per session, P< 0.001; spKt/V, 2.12±0.31 vs 1.83±0.30, P< 0.001). Kaplan–Meier survival analysis indicated that the two groups had similar survival (P=0.983). Multivariate Cox regression analysis showed that age and time-dependent serum albumin were predictors of patient mortality. Subgroup analysis of 62 patients more than 10 years HD vintage also indicated that the two groups had similar survival. During the follow-up, 4 patients dropped out from the twice-weekly HD group and transferred to thrice-weekly HD. Conclusion: The similar survival between twice-weekly HD and thrice-weekly HD in patients with long-term dialysis vintage is likely relating to patient selection, individualized treatment for dialysis patients based on clinical features and socioeconomic factors remains a tough task for the clinicians.

B-type natriuretic peptide levels and volume status in twice-weekly hemodialysis patients

“…Of note, despite that twice-weekly HD tended to have worse hydration status than that of thrice-weekly HD, we found that the two groups had similar survival, this result was consistent with many previous studies [ 6 , 7 , 28 ]. Several factors might contribute to the result: Firstly, a relatively higher rate of patients with maintained urine output in twice-weekly HD group would favor this treatment; secondly, a higher SpKt/V,a longer HD session time and a shorter HD vintage also benefited twice-weekly HD in the study.…”

“…The 2006 K-DOQI guidelines recommended that the target of spKt/ V at least 2.0 for twice-weekly HD patients with residual native kidney urea clearance (Kr) more than 2 mL/min/ 1.73 m 2 , and it is not appropriate for those with Kr less than 2 mL/min/1.73 m 2 selecting this treatment model [4]. Nevertheless, due to financial constraints and resources limitations, it is not uncommon for patients without residual kidney function (RKF) undergoing twice-weekly HD [5][6][7], and some patients have been reported having treatment with twice-weekly HD for more than 20 years HD vintage [7].…”

Associations of Socio-Demographic, Clinical and Biochemical Parameters with Healthcare Cost, Health- and Renal-Related Quality of Life in Hemodialysis Patients: A Clinical Observational Study

“…Though there were a few studies that investigated the costs of dialysis treatments in low–middle income countries, there is a lack of studies conducted among hemodialysis patients in Vietnam [ 19 , 20 ]. In addition, it remains difficult for clinicians to provide individualized care based on socio-demographic characteristics as well as clinical and laboratory parameters [ 21 ]. It has been suggested that factors associated with a decline in HRQOL during renal progression should be investigated [ 22 ].…”

Korean Society of Nephrology 2021 Clinical Practice Guideline for Optimal Hemodialysis Treatment

“…In addition, studies suggest that it is possible to try initiating twice-weekly HD in patients who retain significant residual kidney function. In our meta-analysis of three such studies, the mortality rate tended to increase in HD patients without residual renal function, so such a schedule should be attempted while sufficiently watching changes in the patients' residual renal function [34][35][36].…”