Combined Therapy for Selected Chronic Uremic Patients: Infrequent Hemodialysis and Nutritional Management

Abstract

The results are described of a combined nutritional (supplemented diet) and dialytic (once a week hemodialysis) therapy, employed in 17 selected chronic uremics for a mean period of 18.2 months/patient. The clinical findings, blood chemical abnormalities and changes of renal function were examined and compared with those of patients on the standard thrice-a-week dialysis schedule and free diet. The clinical findings were not significantly different in the two groups. The residual renal function of patients on combined therapy declined faster than in patients on conservative treatment, but at a slower rate than in those on thrice-a-week dialysis. The time averages of serum urea, methylguanidine and phosphate concentrations and their postdialytic rebounds were lower in the patients on combined therapy than in those on thrice-a-week dialysis, whereas the time averages of the serum creatinine concentration were higher, and those of serum bicarbonate and serum oxalate were not significantly different in the two groups. It is concluded that this combined therapy is a valid alternative to the conventional thrice-a-week hemodialysis and free diet for selected patients and for periods of time whose duration is conditioned by the rate of decline of the residual renal function.

Dietary Management of Incremental Transition to Dialysis Therapy: Once-Weekly Hemodialysis Combined With Low-Protein Diet

“…15 Evidence suggests that correct implementation of the nutritional regimen with an appropriate protein and energy intake may reduce the need for a conventional dialysis in particular, in motivated patients who comply with dietary instructions. In the 80s and 90s, Mitch and Sapir, 16 Giovannetti et al, 17 and Locatelli et al 18 proposed a very low-protein diet (0.3 g/kg/day) supplemented with essential amino acids and ketoacids, in combination with only once-weekly hemodialysis. The rationale behind this was to ensure an adequate metabolic control of the patients by reducing generation of uremic toxins upstream and providing some dialytic purification downstream, while preserving RKF longer by avoiding the need for ultrafiltration given that more frequent dialysis could worsen renal perfusion.…”

Effect of Hemodialysis on the Dispersion of the QTc Interval

“…Ten patients were on a 3-times-weekly dialysis schedule and 10 patients were on a once-weekly dialysis combined with dietary treatment [13, 14]. All the patients were treated with acetate-free biofiltration lasting 3.5–4 h. The dialysate composition was: potassium 2 mmol/l, calcium 2 mmol/l, magnesium 0.37 mmol/l, sodium 139 mmol/l.…”

Green nephrology and eco-dialysis: a position statement by the Italian Society of Nephrology

“…Incremental dialysis is of particular interest; the concept, which originated from PD, supports implementing a progressively higher dialysis dose with a progressively reduced residual kidney function [129][130][131][132][133][134][135]. Several schedules are available, whose is beyond the aim of this paper.…”

“…Several schedules are available, whose is beyond the aim of this paper. In any case these patient-friendly approaches seem to allow preserving kidney function and lowering dialysis related comorbidity, in particular in association with dietary management [129][130][131][132][133][134][135]. From an ecologic point of view, incremental dialysis allows us to limit the carbon footprint, wastes and social costs, although, almost paradoxically, the treatment costs borne by the institutions providing care may be higher [136].…”