Twice‐Weekly Hemodialysis in China: Can It Be A Better Option for Initiation or Maintenance Dialysis Therapy?

Yan, Yucheng; Ramirez, Sylvia; Anand, Shuchi; Qian, Jiaqi; Zuo, Li

doi:10.1111/sdi.12588

Cited by 11 publications

(12 citation statements)

References 31 publications

(42 reference statements)

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“…Patients with long interdialytic intervals may be more prone to larger interdialytic weight gain, and intradialytic hypotension increases due to larger fluid removal . In addition, the adequacy of dialysis is another consideration when starting incremental HD . Our study showed that the clinical condition of patients on incremental HD was similar to that of patients on conventional HD, except that they had higher renal function at baseline.…”

Section: Discussionmentioning

confidence: 55%

Comparison between incremental and thrice‐weekly haemodialysis: Systematic review and meta‐analysis

Liu

Zou

et al. 2019

Nephrology

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Section: Discussionmentioning

confidence: 55%

Comparison between incremental and thrice‐weekly haemodialysis: Systematic review and meta‐analysis

Liu

Zou

et al. 2019

Nephrology

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“…In a cross‐sectional report from China in 2013, 26% of HD patients were dialyzing twice weekly . Overall, about one‐fourth of the contemporary dialysis population in China reportedly dialyzes weekly twice and this practice is also very common, although not as well reported, in other South Asian countries …”

Section: Discussionmentioning

confidence: 99%

“…10 Overall, about onefourth of the contemporary dialysis population in China reportedly dialyzes weekly twice and this practice is also very common, although not as well reported, in other South Asian countries. 3,11 In western countries, twice weekly dialysis is much less common. Only 4% of subjects in a USRDS study from 1999 were dialysed twice weekly, and tended to be older, smaller and with lower serum creatinine concentrations.…”

Section: Discussionmentioning

confidence: 99%

Incremental and twice weekly haemodialysis in Australia and New Zealand

et al. 2019

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Background Haemodialysis is usually started at a frequency of three times a week, with occasional patients starting twice weekly (‘incremental dialysis’). Incremental haemodialysis (HD) may preserve residual kidney function and has been associated with reduced mortality. In the present study, we report prevalence and outcomes of incremental dialysis in Australia and New Zealand. Methods The cohort was all adults starting renal replacement therapy with HD in Australia and New Zealand 2004–2015. We used cox proportional hazards modelling with a primary exposure of dialysis frequency at first survey date (≥ or <3 times per week). The primary outcome was all‐cause mortality (primary), cardiovascular and non‐cardiovascular mortality (secondary). Results Eight‐hundred fifty of 27 513 subjects were started on twice weekly HD (prevalence 3%). Compared to conventional patients, incremental dialysis patients were older (67 vs 62 years, P < 0.001), had a lower body mass index (26.1 vs 27.7 kg/m2, P < 0.001), had a higher starting estimated glomerular filtration rate (7.59 vs 6.66 mL/min P < 0.001) and had less diabetes (39.2% vs 50.2%, P < 0.001). In a multivariate model, incremental start dialysis was not associated with all‐cause mortality (hazard ratio (HR) = 1.03, 95% confidence interval (CI) = 0.92–1.16) or cardiovascular mortality (HR = 0.87, 95% CI = 0.71–1.07), but was associated with an increased risk of non‐cardiovascular mortality (HR = 1.25, 95% CI = 1.11–1.42). Conclusion Incremental dialysis was used infrequently, and there was evidence of patient level differences. All‐cause mortality was similar, but there were differences in cause specific mortality. Incremental dialysis needs to be tested in prospective trials to define the safety and efficacy of this approach.

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“…This paradigm shift has also led to renewed interest in “late” and, whenever possible, incremental dialysis initiation, in which, as occurs in peritoneal dialysis, hemodialysis is prescribed with a progressive increase in the number and duration of sessions to try to minimize “dialysis shock” and preserve residual renal function [ 37 , 38 , 39 , 40 , 41 , 42 ].…”

Section: Tolerance Beyond Depurationmentioning

confidence: 99%

“…At dialysis start, incremental policies allow us to test for tolerance, starting with once- or twice-weekly sessions of 2–3 h, and progressively increasing frequency or duration according to need for increasing depuration or ultrafiltration and to tolerance [ 37 , 38 , 39 , 40 , 41 , 123 , 124 , 125 , 126 , 127 , 128 , 129 ] ( Figure 6 ).…”

Section: Poor Nutritional Status Poor Clinical Condition High MImentioning

confidence: 99%

Prescribing Hemodialysis or Hemodiafiltration: When One Size Does Not Fit All the Proposal of a Personalized Approach Based on Comorbidity and Nutritional Status

Piccoli

Nielsen

Gendrot

et al. 2018

JCM

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There is no simple way to prescribe hemodialysis. Changes in the dialysis population, improvements in dialysis techniques, and different attitudes towards the initiation of dialysis have influenced treatment goals and, consequently, dialysis prescription. However, in clinical practice prescription of dialysis still often follows a “one size fits all” rule, and there is no agreed distinction between treatment goals for the younger, lower-risk population, and for older, high comorbidity patients. In the younger dialysis population, efficiency is our main goal, as assessed by the demonstrated close relationship between depuration (tested by kinetic adequacy) and survival. In the ageing dialysis population, tolerance is probably a better objective: “good dialysis” should allow the patient to attain a stable metabolic balance with minimal dialysis-related morbidity. We would like therefore to open the discussion on a personalized approach to dialysis prescription, focused on efficiency in younger patients and on tolerance in older ones, based on life expectancy, comorbidity, residual kidney function, and nutritional status, with particular attention placed on elderly, high-comorbidity populations, such as the ones presently treated in most European centers. Prescription of dialysis includes reaching decisions on the following elements: dialysis modality (hemodialysis (HD) or hemodiafiltration (HDF)); type of membrane (permeability, surface); and the frequency and duration of sessions. Blood and dialysate flow, anticoagulation, and reinfusion (in HDF) are also briefly discussed. The approach described in this concept paper was developed considering the following items: nutritional markers and integrated scores (albumin, pre-albumin, cholesterol; body size, Body Mass Index (BMI), Malnutrition Inflammation Score (MIS), and Subjective Global Assessment (SGA)); life expectancy (age, comorbidity (Charlson Index), and dialysis vintage); kinetic goals (Kt/V, normalized protein catabolic rate (n-PCR), calcium phosphate, parathyroid hormone (PTH), beta-2 microglobulin); technical aspects including vascular access (fistula versus catheter, degree of functionality); residual kidney function and weight gain; and dialysis tolerance (intradialytic hypotension, post-dialysis fatigue, and subjective evaluation of the effect of dialysis on quality of life). In the era of personalized medicine, we hope the approach described in this concept paper, which requires validation but has the merit of providing innovation, may be a first step towards raising attention on this issue and will be of help in guiding dialysis choices that exploit the extraordinary potential of the present dialysis “menu”.

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Twice‐Weekly Hemodialysis in China: Can It Be A Better Option for Initiation or Maintenance Dialysis Therapy?

Cited by 11 publications

References 31 publications

Comparison between incremental and thrice‐weekly haemodialysis: Systematic review and meta‐analysis

Comparison between incremental and thrice‐weekly haemodialysis: Systematic review and meta‐analysis

Incremental and twice weekly haemodialysis in Australia and New Zealand

Prescribing Hemodialysis or Hemodiafiltration: When One Size Does Not Fit All the Proposal of a Personalized Approach Based on Comorbidity and Nutritional Status

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