Incremental Hemodialysis Schedule in Patients with Higher Residual Renal Function at the Start of Dialysis

Abstract

We present an observational study to evaluate a progressive schedule of dose of dialysis, starting with 2 HD/week, when the renal clearance of urea was equal to or greater than 2,5 mL/min/1,73 m2and the patient is in a stable clinical situation. From 2006 to 2011, 182 patients started hemodialysis in our center, of which 134 were included in the study. Residual renal function (RRF), Kt/V, eKru, nPCR, hemoglobin, weekly erythropoietin dose, and beta-2-microglobulin were determined at 6, 12, 18, 24, and 30 months after dialysis initiation. Seventy patients (52%) began with the progressive schedule of 2 HD/week and 64 (48%) patients began with the conventional thrice-weekly schedule (3 HD/week). The decline of RRF was lower in the group of 2 HD/week: 0,20 (0,02–0,53) versus 0,50 (0,14–1,08) mL/min/month (median and interquartile range,P=0,009). No relationship was found between the decline rate and the basal RRF. Survival analysis did not show differences between both groups. Our experience demonstrates that patients with higher residual renal function may require less than conventional 3 HD sessions per week at the start of dialysis. Twice-weekly hemodialysis schedule is safe and cost-effective and may have additional benefit in maintaining the residual renal function.

Incremental Versus Conventional Hemodialysis for Preservation of Residual Kidney Function in Patients on Regular Hemodialysis

“…9 A. Mathew et al reported that, no statistical disparity with all-cause mortality in subgroups of age , gender , ethnicity, central venous catheter use or diabetes condition in preset subgroup analyses of the matched cohort compared incremental HD to conventional HD. 7 We found marked increase in UOP in incremental group; compared to conventional group; during the serial measurements (p < 0.05), which came in agreement with Liu et al 9 , A. Mathew et al 7 , Lucas et al 8 ,A. T. Mathew et al 10 and Merino et al 11 Liu et alreported that those on incremental HD appeared to be female and thinner relative to those on traditional HD. The amount of urine in the incremental HD group was higher relative to the conventional HD group 9.…”

“…Regarding Baseline data, we found that; the mean age of all patients was (45.95 ± 2.97) years, and the average UOP was (1124.3 ± 337.2) ml/day. Regarding gender of the patients, the majority (60%) of patients were males; while (40%) were females, with (65%) had DM, and (75%) had HTN, which came in agreement with A. Mathew et al 7 and Lucas et al 8 .…”

“…Regarding Outcome data, (20%) of patients had hypotension, (15%) had hospital admission, while nobody suffered mortality, which came in agreement with Lucas et al 8 Lucas et al reported thatin the 2-and 3-HD / week groups, hospitalization period was 4 (0-15) and 11 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) days/patient-years, respectively (median and IQR, = 0, 068). 8 No substantial difference in the comparative study between the 2 groups with respect to all basic clinical data (p > 0.05) , which came in agreement with A. Mathew et al 7 , Lucas et al 8 and Liu et al . 9 A. Mathew et al reported that, no statistical disparity with all-cause mortality in subgroups of age , gender , ethnicity, central venous catheter use or diabetes condition in preset subgroup analyses of the matched cohort compared incremental HD to conventional HD.…”

Initiating haemodialysis twice-weekly as part of an incremental programme may protect residual kidney function

“…Dialysis strategies that protect RKF may therefore be beneficial. Observational studies have suggested that patients commencing 2XHD may have a slower rate of decline of RKF [22][23][24]. Incremental dialysis, whereby dialysis dose is individualized according to the prevailing level of RKF [8], might protect against RKF loss by reducing dialysis intensity for patients who retain significant RKF.…”

Measuring Residual Renal Function in Hemodialysis Patients without Urine Collection

“…Loss of RRF is a strong predictor of mortality and there are compelling reasons to preserve RRF . Knowledge of RRF not only provides useful prognostic information to clinicians but there has also been a resurgent interest to incorporate RRF in the hemodialysis prescription as part of ‘incremental dialysis’ with suggestions that it may help to preserve RRF .…”