Incremental short daily home hemodialysis: a case series

• Published in: BMC nephrology Vol. 18; no. 1; p. 216
• Main Authors: Toth-Manikowski, Stephanie M, Mullangi, Surekha, Hwang, Seungyoung, Shafi, Tariq
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.07.2017; BioMed Central; BMC
• Subjects: Care and treatment; Case Report; Case studies; Diagnosis; Dialysis Solutions - administration & dosage; Effluents; Female; Fistulae; Follow-Up Studies; Health aspects; Hemodialysis; Hemodialysis, Home - methods; Home hemodialysis; Humans; Incremental hemodialysis; Kidney - drug effects; Kidney - physiology; Kidney diseases; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - therapy; Kt/V; Laboratories; Longevity; Male; Nephrology; NxStage; Patients; Quality of life; Residual kidney function; Retrospective Studies; Time Factors; Transplants & implants; Urea; Uremic toxins; Urine; United States; United States > US; Incremental hemodialysis; Uremic toxins; Home hemodialysis; Kt/V; Residual kidney function; NxStage
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-017-0651-1

Patients starting dialysis often have substantial residual kidney function. Incremental hemodialysis provides a hemodialysis prescription that supplements patients' residual kidney function while maintaining total (residual + dialysis) urea clearance (standard Kt/Vurea) targets. We describe our experience with incremental hemodialysis in patients using NxStage System One for home hemodialysis. From 2011 to 2015, we initiated 5 incident hemodialysis patients on an incremental home hemodialysis regimen. The biochemical parameters of all patients remained stable on the incremental hemodialysis regimen and they consistently achieved standard Kt/Vurea targets. Of the two patients with follow-up >6 months, residual kidney function was preserved for ≥2 years. Importantly, the patients were able to transition to home hemodialysis without automatically requiring 5 sessions per week at the outset and gradually increased the number of treatments and/or dialysate volume as the residual kidney function declined. An incremental home hemodialysis regimen can be safely prescribed and may improve acceptability of home hemodialysis. Reducing hemodialysis frequency by even one treatment per week can reduce the number of fistula or graft cannulations or catheter connections by >100 per year, an important consideration for patient well-being, access longevity, and access-related infections. The incremental hemodialysis approach, supported by national guidelines, can be considered for all home hemodialysis patients with residual kidney function.