Abstract
Registry or national dialysis data show that a sizeable proportion of contemporary dialysis patients have substantial levels of residual kidney function especially upon transitioning to dialysis therapy. However, among incident hemodialysis patients, the prevailing paradigm has been to initiate "full-dose" triweekly treatment schedules irrespective of native kidney function in most developed countries. Recognizing the benefits of residual kidney function upon the health and survival of dialysis patients, there has been growing interest in incremental hemodialysis, in which dialysis frequency and dose are tailored according to the degree of patients' residual kidney function. Infrequent hemodialysis can also be used for those who prefer a more conservative approach in managing uremia. Clinical practice guidelines support the use of twice-weekly hemodialysis among patients with adequate residual kidney function (renal urea clearance >3 mL/min/1.73 m2), and a growing body of evidence indicates that incremental hemodialysis is associated with better preservation of residual kidney function without adversely impacting survival. Nonetheless, incremental hemodialysis remains an underutilized approach in this population. In this review, we will discuss the history of the twice- versus triweekly hemodialysis schedules; current clinical practice guidelines regarding infrequent hemodialysis; emerging data on incremental treatment regimens and outcomes; and guidelines for the practical implementation of incremental and infrequent hemodialysis in the clinical setting.
Highlights
Each year, approximately 100,000 patients transition to hemodialysis as a live-saving therapy for end-stage renal disease (ESRD) in the United States (US).[1]
The objectives of this review are to discuss the origins of the twice- versus thrice-weekly hemodialysis schedule; current clinical practice guidelines regarding hemodialysis frequency; rationale for incremental and infrequent hemodialysis regimens and emerging data on relevant outcomes; and recommendations on its implementation in clinical practice
Among patients with substantial residual kidney function (KRU of >3ml/min/1.73m2), the 2006 Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines indicated that the minimal session single pool Kt/V can be reduced and twice-weekly hemodialysis would be permissible
Summary
Approximately 100,000 patients transition to hemodialysis as a live-saving therapy for end-stage renal disease (ESRD) in the United States (US).[1]. An increasing body of evidence suggests that an incremental and infrequent hemodialysis schedule, in which dialysis frequency and dose are tailored according to degree residual kidney function, may be a more optimal regimen for patients initiating treatment with considerable native kidney function.[2,3,4,5,6,7,8,9,10,11] Those who prefer a more conservative hemodialysis treatment approach may prefer the infrequent hemodialysis regimen such as once to twice-weekly dialysis sessions. The objectives of this review are to discuss the origins of the twice- versus thrice-weekly hemodialysis schedule; current clinical practice guidelines regarding hemodialysis frequency; rationale for incremental and infrequent hemodialysis regimens and emerging data on relevant outcomes; and recommendations on its implementation in clinical practice
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
