Incremental and Twice-Weekly Hemodialysis Program in Practice

Murea, Mariana; Kalantar-Zadeh, Kamyar

doi:10.2215/cjn.04170320

Cited by 13 publications

(14 citation statements)

References 8 publications

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“…However, incremental transition to peritoneal dialysis and home haemodialysis have benefits beyond the potential preservation of residual kidney function, including greater preservation of the peritoneal membrane and decreased access cannulation, respectively. Randomized, controlled trials that aim to compare the impact of incremental and conventional transition to dialysis on reducing dialysis-related symptoms are ongoing 96,103,104 .…”

Section: Management Of Unpleasant Symptoms In Ckdmentioning

confidence: 99%

Patient-centred approaches for the management of unpleasant symptoms in kidney disease

et al. 2022

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Patients with chronic kidney disease (CKD) frequently experience unpleasant symptoms. These can be gastrointestinal (constipation, nausea, vomiting and diarrhoea), psychological (anxiety and sadness), neurological (lightheadedness, headache and numbness), cardiopulmonary (shortness of breath and oedema), dermatological (pruritus and dry skin), painful (muscle cramps, chest pain and abdominal pain) or involve sexual dysfunction, sleep disorders and fatigue. These symptoms often occur in clusters, with one of them as the lead symptom and others as secondary symptoms. Uraemic toxins (also called uremic toxins) are often considered to be the main cause of CKD-associated symptom burden, but treatment of uraemia by dialysis often fails to resolve them and can engender additional symptoms. Indeed, symptoms can be exacerbated by comorbid conditions, pharmacotherapies, lifestyle and dietary regimens, kidney replacement therapy and ageing. Patients with kidney disease, including those who depend on dialysis or transplantation, should feel actively supported in their symptom management through the identification and targeting of unpleasant symptoms via a tailored palliative care approach. Such an approach may help minimize the burden and consequences of kidney disease, and lead to improved patient outcomes including health-related quality of life and better life participation.

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Section: Management Of Unpleasant Symptoms In Ckdmentioning

confidence: 99%

Patient-centred approaches for the management of unpleasant symptoms in kidney disease

et al. 2022

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“…There is also the potential for intermittent and temporary decline in RKF with intercurrent acute illness. 55,63 For these reasons and pending more research on HD therapy adjustment by residual renal urea clearance levels, conservative renal urea clearance intervals could be considered for clinical staging. From a treatment standpoint, HD treatments with dialysis spKt/Vurea ≥1.20 can be provided once-weekly until residual renal urea clearance falls to <4.0 ml/min/35 L, and twice-weekly until residual renal urea clearance falls to <2.0 ml/min/35 L. [56][57][58] More frequent HD in the form of four or five times per week can also be considered.…”

Section: Several Ongoing Clinical Trials Use Similar Renal Urea Clear...mentioning

confidence: 99%

“…The formal recognition of KDRD as a collection of heterogeneous kidney diseases with varying degrees of RKF may help eliminate the reluctance to accept alternative dialysis schedules and personalize treatment, to improve patients' quality of life and clinical outcomes. 63,93 Many would argue that, absent clinical practice substantiation from clinical trials and in the present era of using high-performance dialyzers, the frequency of HD treatments is partly driven by payor policy of payment for three HD sessions per week. Yet, we fail to consider that, akin to harmful effects reported with medical overtreatment of other conditions, 94-96 thrice-weekly HD may have detrimental effects in patients who could otherwise have been effectively treated, at least temporarily, with less frequent HD.…”

Section: Clinical Implications Of a Staging Model Of Kdrdmentioning

confidence: 99%

The spectrum of kidney dysfunction requiring chronic dialysis therapy: Implications for clinical practice and future clinical trials

Murea

Deira

Kalantar-Zadeh

et al. 2021

Seminars in Dialysis

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Staging to capture kidney function and pathophysiologic processes according to severity is widely used in chronic kidney disease or acute kidney injury not requiring dialysis. Yet the diagnosis of "end-stage kidney disease" (ESKD) considers patients as a single homogeneous group, with negligible kidney function, in need of kidney replacement therapy. Herein, we review the evidence behind the heterogeneous nature of ESKD and discuss potential benefits of recasting the terminology used to describe advanced kidney dysfunction from a monolithic entity to a disease with stages of ascending severity. We consider kidney assistance therapy in lieu of kidney replacement therapy to better reconcile all available types of therapy for advanced kidney failure including dietary intervention, kidney transplantation, and dialysis therapy at varied schedules. The lexicon "kidney dysfunction requiring dialysis" (KDRD) with stages of ascending severity based on levels of residual kidney function (RKF)that is, renal urea clearance-and manifestations related to uremia, fluid status, and other abnormalities is discussed. Subtyping KDRD by levels of RKF could advance dialysis therapy as a form of kidney assistance therapy adjusted based on RKF and clinical symptoms. We focus on intermittent hemodialysis and underscore the need to personalize dialysis treatments and improve characterization of patients included in clinical trials.

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“…8 Almost all data concerning HD initiation has been derived from patients undergoing thrice-weekly HD with few twice-weekly HD patients studied. 9,10 Twice-weekly HD for treating ESRD is not a popular choice and is often regarded as inadequate in a high-income country. It is however commonly prescribed in resource-limited settings.…”

Section: Introductionmentioning

confidence: 99%

Early as compared to late initiation of twice‐weekly hemodialysis and short‐term survival among end‐stage renal disease patients

Panaput

Domrongkitchaiporn

Thinkhamrop

et al. 2022

Hemodialysis International

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Introduction:The impact of timing of hemodialysis (HD) for end-stage renal disease (ESRD) patients treated with twice-weekly HD remains unclear. We aimed to determine the effects of late initiation of HD on short-term mortality and hospitalization.Methods: A multicenter cohort study was conducted in 11 HD centers in Northeastern Thailand (HEmodialysis Network of the NorthEastern Thailand study group). We recruited adult ESRD patients who were treated with twiceweekly HD for more than 3 months and had data on eGFR at HD initiation.Clinical and laboratory values at the time of recruitment were recorded. Late and early (eGFR at start <5 and >5 ml/min/1.73 m 2 ) initiations were defined.Outcomes were disease-related death (excluding any accidental deaths) and first hospitalization. Data analysis was performed by multivariable coxregression analysis.Findings: A total of 407 patients who had data on eGFR at HD initiation (303 in late group and 104 in early group) were included for analysis. There were 56.8% male with a mean age of 55 years. During the 15.1 months of follow-up, there were 27 (6.6%) disease-related deaths. The 1-year survival rate was similar among late and early initiation groups. The incidence density of first hospitalization in the late group was significantly lower than those in the early group (HR adjusted, 0.63; 95% CI, 0.40-0.99, p = 0.047). Among 303 patients who were in the late start group, patients with diabetes had a higher mortality rate (HR, 3.49; 95% CI, 1.40-8.70, p = 0.007) when compared to non-diabetic patients.Discussion: Early initiation of HD at eGFR >5 ml/min/1.73 m 2 had no shortterm survival benefit compared to the late group in ESRD patients treated with

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Incremental and Twice-Weekly Hemodialysis Program in Practice

Cited by 13 publications

References 8 publications

Patient-centred approaches for the management of unpleasant symptoms in kidney disease

Patient-centred approaches for the management of unpleasant symptoms in kidney disease

The spectrum of kidney dysfunction requiring chronic dialysis therapy: Implications for clinical practice and future clinical trials

Early as compared to late initiation of twice‐weekly hemodialysis and short‐term survival among end‐stage renal disease patients

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