Feasibility of Incremental 2-Times Weekly Hemodialysis in Incident Patients With Residual Kidney Function

• Published in: Kidney international reports Vol. 2; no. 5; pp. 933 - 942
• Main Authors: Chin, Andrew I, Appasamy, Suresh, Carey, Robert J, Madan, Niti
• Format: Journal Article
• Language: English
• Published: United States Elsevier 01.09.2017
• Subjects: Clinical Research; hemodialysis; incremental hemodialysis; residual renal function; residual renal function; hemodialysis; incremental hemodialysis
• ISSN: 2468-0249; 2468-0249
• DOI: 10.1016/j.ekir.2017.06.005

We hypothesized that at least half of incident hemodialysis (HD) patients on 3-times weekly dialysis could safely start on an incremental, 2-times weekly HD schedule if residual kidney function (RKF) had been considered. RKF is assessed in all our HD patients. This single-center, retrospective cohort study of incident adult HD patients, who survived ≥6 months on a 3-times weekly HD regimen and had a timed urine collection within 3 months of starting HD, assessed each patient's theoretical ability to achieve adequate urea clearance, ultrafiltration rate, and hemodynamic stability if on 2-times weekly HD. Of the 410 patients in the cohort, we found that 112 (27%) could have optimally and 107 (26%) could have been appropriately considered for 2-times weekly incremental HD. In general, diuretics were underutilized in >50% of subjects who had adequate RKF urea clearance. The optimal 2-times weekly patients had better potassium and phosphorus control. The correlation coefficient of calculated residual kidney urea clearance with 24-hour urine volume and with kinetic model residual kidney clearance was 0.68 and 0.99, respectively. More than 50% of incident HD patients with RKF have adequate kidney urea clearance to be considered for 2-times weekly HD. When additionally ultrafiltration volume and blood pressure stability are taken into account, more than one-fourth of the total cohort could optimally start HD in an incremental fashion.