Hemodialysis 1991

Blagg, Christopher R.

doi:10.1159/000170070

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…23 Unfortunately, however, no clinical trials have compared twice-weekly vs thrice-weekly HD. Currently, in some countries, including India and China, over half of HD patients receive ≤2 treatments per week.…”

Section: Relationship Of Twice-weekly Hd To Outcomesmentioning

confidence: 99%

Twice-Weekly and Incremental Hemodialysis Treatment for Initiation of Kidney Replacement Therapy

Kalantar-Zadeh

Unruh

Zager

et al. 2014

American Journal of Kidney Diseases

151

157

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Mortality is highest in the first months of maintenance hemodialysis (HD). In many Western countries, patients who transition to kidney replacement therapy usually begin thrice-weekly HD regardless of their level of residual kidney function (RKF). RKF is a major predictor of survival. RKF may decline more rapidly with more thrice-weekly HD treatments, is associated with a reduced need for dialytic solute clearance, and is an important factor in the prescription of peritoneal dialysis. In this paper we review the concept of incremental HD, in which weekly dialysis dose, in particular HD treatment frequency, is based on a variety of clinical factors such as RKF (including urine output >0.5 L/day), volume status, cardiovascular symptoms, body size, potassium and phosphorus levels, nutritional status, hemoglobin, comorbid conditions, hospitalizations, and health related quality of life. These ten clinical criteria may identify which patients might benefit from beginning maintenance HD twice-weekly. Periodic monitoring of these criteria will determine the timing for increasing dialysis dose and frequency. We recognize that twice-weekly HD represents a major paradigm shift for many clinicians and jurisdictions. Therefore, we propose conducting randomized controlled trials of twice-weekly vs. thrice-weekly HD to assess the potential of twice-weekly HD to improve survival and health related quality of life while simultaneously reducing costs, protecting fragile vascular accesses, and optimizing resource use. Such incremental and individualized HD therapy may prove to be the most appropriate approach for transitioning to dialytic therapy.

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Section: Relationship Of Twice-weekly Hd To Outcomesmentioning

confidence: 99%

Twice-Weekly and Incremental Hemodialysis Treatment for Initiation of Kidney Replacement Therapy

Kalantar-Zadeh

Unruh

Zager

et al. 2014

American Journal of Kidney Diseases

151

157

View full text Add to dashboard Cite

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“…A very large dose of dialysis can be delivered with short or very short times of dialysis using large blood flows and highly efficient artificial kid neys [10,[27][28][29]. Adequate nutrition is more difficult to achieve as discussed by Blagg [51]: even a slight underdi alysis results in loss of appetite, inadequate protein and caloric intake. At the same time, dialysis-induced catabo lism [52] makes it reasonable to propose that HD patients require a higher than normal protein intake.…”

Section: Effects O F Increasing Dialysis Timementioning

confidence: 99%

Importance of Treatment Time and Blood Pressure Control in Achieving Long-Term Survival on Dialysis

Charra¹,

Calemard²,

Laurent³

1996

Am J Nephrol

193

138

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A drastic reduction in hemodialysis (HD) time has been based on the dialysis dose measurement in terms of urea Kt/V exclusively and on the use of high efficiency dialysers. It was subtly coupled to a de-emphasis of the use of HD to normalize blood pressure. In Tassin we have maintained long slow HD with an overall excellent patient survival. We analyze the influence of the different factors of this survival: the place of dry weight and blood pressure control without use of antihypertensive medication is emphasized, and the role of dialysis dose and nutrition is discussed. Adequacy should be defined in terms of these additive conditions. Long slow HD allows one to fulfill these conditions easily. Shortening of dialysis time should not interfere with the control of blood pressure.

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“…Among the various modalities of treatment, home hemodialysis has rapidly shown many advantages; it offers excellent survival [5, 6, 7, 8, 9], rehabilitation [10], quality of life [11, 12, 13, 14]and in addition is also less expensive than center hemodialysis [15, 16]. For all these reasons, this mode of therapy should have progressively increased, but paradoxically, since 1980, home hemodialysis has continuously declined [16, 17].…”

Section: Introductionmentioning

confidence: 99%