Abstract
Abstract Background and Aims We investigated the feasibilty of converting stable end stage renal disease (ESRD) patients from three to twice weekly hemodialysis (HD) sessions based on published criteria. Method ESRD patients on three times weekly (3xwkly) HD sessions for at least 3 months duration were screened for eligibility for conversion to twice weekly (2xwkly) maintenace HD schedule in a university-affiliated community dialysis program. Eligibility criteria were: residual renal function > 3ml/min; urine output >500mL/day; intradialytic weight gain <2.5kg; hemoglobin >8gm/dL; manageable phosphorus and potasium levels. Clinical parameters on 3xwkly vs. 2xwkly HD sessions were then performed in the eligible patients. Results 7/71 (9.8%) of the patients met criteria for conversion to 2xwkly HD sessions. Baseline patient characteristics are shown in Table 1. Major indication for HD initiation was symptomatic progression of disease. Less than 50% of patients had a functioning arteriovenous fistula at initiation of HD. In the current cohort, residual renal function > 3mL/min was maintainedfor >200 days after initiation of HD. There were no significant changes in electrolytes, hemoglobin, nutrition staus or adequacy of dialysis. PTH levels were not significantly different: 3xwkly, 625.7 + 546.2pg/mL vs. 2xwkly, 399 + 344.2pg/mL; p=0.374). Karnofsky Performance Status Scale improved post conversion but did not achieve statistical significance (3xwkly, 57.1 vs. 2xwkly, 70; p=0.316). There were no hospital admissions since conversion to 2xwkly schedule during the study period. Conclusion In a community-based dialysis program, 10% of total HD patients qualified for conversion from 3xwkly to 2xwkly maintenance HD without significant changes to their laboratory or clinical performance measures. These observations stimulate discussion regarding increased application of incremental dialysis initiation strategies to preserve residual renal function, increase dialysis-free days and alleviate transportation and care provider-related burden to patients and families.
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