Tailoring dialysis and resuming low‐protein diets may favor chronic dialysis discontinuation: Report on three cases

Abstract

Renal function recovery (RFR), defined as the discontinuation of dialysis after 3 months of replacement therapy, is reported in about 1% of chronic dialysis patients. The role of personalized, intensive dialysis schedules and of resuming low-protein diets has not been studied to date. This report describes three patients with RFR who were recently treated at a new dialysis unit set up to offer intensive hemodialysis. All three patients were females, aged 73, 75, and 78 years. Kidney disease included vascular-cholesterol emboli, diabetic nephropathy and vascular and dysmetabolic disease. At time of RFR, the patients had been dialysis-dependent from 3 months to 1 year. Dialysis was started with different schedules and was progressively discontinued with a "decremental" policy, progressively decreasing number and duration of the sessions. A moderately restricted low-protein diet (proteins 0.6 g/kg/day) was started immediately after dialysis discontinuation. The most recent update showed that two patients are well off dialysis for 5 and 6 months; the diabetic patient died (sudden death) 3 months after dialysis discontinuation. Within the limits of small numbers, our case series may suggest a role for personalized dialysis treatments and for including low-protein diets in the therapy, in enhancing long-term RFR in elderly dialysis patients.

Diet as a system: an observational study investigating a multi-choice system of moderately restricted low-protein diets

“…Over time, the approach to LPDs shifted from the proposal of two main LPDs (0.6 g/Kg/day: vegan-vegetarian supplemented with alpha-ketoacids and aminoacids (LPD-AK) and with protein-free commercial food (LPD-PFF)), which were eventually merged into one very-low protein diet (vLPD), to a more integrated choice including different combinations of the previous diets and vegan non-supplemented diets [20, 33–36] (Table 1). …”

“…We analyzed a large single-center cohort of on-diet patients (449 patients, 847 patient-years of observation, in which diets, mainly with a moderate protein restriction, and controls follow a personalized schedule of prescriptions and check-ups, adapted to the various clinical situations [20, 33–36]. …”

Unanticipated concerns in initiating dialysis therapy for very old adults are common

“…In this issue of Hemodialysis International, Piccoli et al. report three women aged 73, 75, and 78 years old on maintenance hemodialysis who underwent renal function recovery, defined as return of renal function sufficient to permit discontinuation of dialysis, after 3 or more months of treatment . A question posed by this experience is whether specific—as yet unidentified—variables in treatment might predispose some dialysis patients to renal functional recovery.…”

“…In this issue of Hemodialysis International, Piccoli et al report three women aged 73, 75, and 78 years old on maintenance hemodialysis who underwent renal function recovery, defined as return of renal function sufficient to permit discontinuation of dialysis, after 3 or more months of treatment. 3 A question posed by this experience is whether specific-as yet unidentified-variables in treatment might predispose some dialysis patients to renal functional recovery. These three women had been dialyzed according to individualized schedules that progressively decreased both frequency and duration of administered dialyses treatments, followed by low-protein diet feeding (proteins 0.6 g/kg/day) immediately after dialysis discontinuation.…”

“…15 For CKD and ESRD patients with diabetes, the number one diagnosis responsible for renal failure in the United Table 1 Unanticipated surprises in maintenance hemodialysis patients 1. Recovery of renal function during maintenance hemodialysis occurs in a small cohort of treated patients 3 2. Patients reporting that prior to starting their dialysis treatment neither options in uremia therapy nor their relative survival were discussed with them by their nephrologist 4 3.…”