Comparison of nutritional and hydration status in patients undergoing twice and thrice-weekly hemodialysis: a silent drama in developing countries

Nieves-Anaya, Iris; M, Vargas; Mayorga, H; García, Olga P.; Colin-Ramírez, Eloisa; Atilano-Carsi, Ximena

doi:10.1007/s11255-020-02697-3

Cited by 3 publications

(3 citation statements)

References 44 publications

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“…Of the 26 included studies, 22 were observational cohort studies [ 4 , 6 , 19–30 , 32–37 , 39 , 40 ], two were RCTs [ 31 , 38 ], one was a non-RCT [ 18 ] and one employed a pre-post study design [ 17 ]. Ten studies were performed in Europe [ 4 , 6 , 18 , 19 , 22 , 25 , 28 , 36 , 37 , 38 ], nine in Asia [ 17 , 21 , 24 , 26 , 27 , 30 , 34 , 35 , 40 ], five in North America [ 23 , 29 , 31–33 ], one in North Africa [ 20 ] and one in Oceania [ 39 ].…”

Section: Resultsmentioning

confidence: 99%

“…In the majority of studies ( n = 18) the decision to initiate patients on incremental HD was determined by clinical parameters and in circumstances whereby it was deemed appropriate by the treating physician [ 4 , 6 , 17–19 , 21–25 , 28 , 29 , 31 , 33 , 37–40 ]. In eight studies, less frequent dialysis was prescribed for socio-economic reasons such as the financial limitations or insurance coverage of patients or the lack of available of dialysis services [ 20 , 26 , 27 , 30 , 32 , 34–36 ].…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies examined the impact of incremental versus conventional HD on hospitalization [ 4 , 18 , 21 , 24 , 25 , 28 , 30–32 , 34 , 37 , 38 , 40 ]. Of the observational studies, seven found no significant difference in hospitalization between the two groups [ 21 , 24 , 28 , 30 , 34 , 37 , 40 ], two found hospitalization rates to be significantly lower in the incremental group [ 4 , 25 ] and one suggested incremental HD posed an increased risk of hospitalization [ 32 ].…”

Section: Resultsmentioning

confidence: 99%

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Impact of incremental initiation of haemodialysis on mortality: a systematic review and meta-analysis

Caton

Sharma

Farrington

2022

Nephrology Dialysis Transplantation

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Background Incremental haemodialysis initiation entails lower sessional duration and/or frequency than the standard four hours thrice-weekly approach. Dialysis dose is increased as residual kidney function (RKF) declines. This systematic review evaluates its safety, efficacy and cost-effectiveness. Methods We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library databases from inception to 27th February 2022. Eligible studies compared incremental haemodialysis (sessions either < 3 times weekly or of duration < 3.5 hours) with standard treatment. The primary outcome was mortality. Secondary outcomes included treatment-emergent adverse events, loss of RKF, quality of life and cost effectiveness. The study protocol was prospectively registered. Risk of bias assessment used the Newcastle-Ottawa Scale and the revised Cochrane risk of bias tool, as appropriate. Meta-analyses were undertaken in Review Manager, Version 5.4. Results 644 records were identified. 26 met the inclusion criteria—including 22 cohort studies and two randomised controlled trials (RCTs). Sample size ranged from 48 to 50 596 participants (total 101 476). We found no mortality differences (HR = 0.99; 95% CI: 0.80–1.24). Cohort studies suggested similar hospitalisation rates though the two small RCTs suggested less hospitalisation after incremental initiation (RR = 0.31; 95% CI: 0.18- 0.54). Data on other treatment emergent adverse events and quality of life was limited. Observational studies suggested reduced loss of RKF in incremental haemodialysis. This was not supported by RCT data. Four studies reported reduced costs of incremental treatments. Conclusions Incremental initiation of haemodialysis does not confer greater risk of mortality compared to standard treatment. Hospitalisation may be reduced and costs are less.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Impact of incremental initiation of haemodialysis on mortality: a systematic review and meta-analysis

Caton

Sharma

Farrington

2022

Nephrology Dialysis Transplantation

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Incremental versus conventional haemodialysis in end-stage kidney disease: a systematic review and meta-analysis

Takkavatakarn,

Jintanapramote,

Phannajit

et al. 2023

Clinical Kidney Journal

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Introduction Appropriate dialysis prescription in the transitional setting from chronic kidney disease to end-stage kidney disease is still challenging. Conventional thrice weekly hemodialysis (HD) might be associated with rapid loss of residual kidney function (RKF) and high mortality. The benefits and risks of incremental HD, compared with conventional HD were explored in this systematic review and meta-analysis. Methods We searched MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials up to April 2023 for studies that compared the impacts of incremental (once- or twice-weekly HD) and conventional thrice-weekly HD on cardiovascular events, RKF, vascular access complications, quality of life, hospitalization, and mortality. Results A total of 36 articles (138,939 participants) were included in this meta-analysis. The mortality rate and cardiovascular events were similar between incremental and conventional HD (OR 0.87; 95% CI 0.72-1.04 and OR 0.67; 95% CI 0.43-1.05, respectively). However, hospitalization and loss of RKF were significantly lower in patients treated with incremental HD (OR 0.54; 95% CI 0.32-0.89 and OR 0.31; 95% CI 0.25-0.39, respectively). In a sensitivity analysis that included studies restricted to those with RKF or urine output criteria, incremental HD had significantly lower cardiovascular events (OR 0.22; 95% CI 0.08-0.63) and mortality (OR 0.54; 95% CI 0.37-0.79). Vascular access complications, hyperkalemia, and volume overload were not statistically different between groups. Conclusions Incremental HD has been shown to be safe and may provide superior benefits in clinical outcomes, particularly in appropriately selected patients. Large-scale randomized controlled trials are required to confirm these potential advantages.

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Mortality associated with the COVID-19 pandemic in the Swiss dialysis population beyond SARS-CoV-2 infection

Jaques,

Hoessly,

Guidotti

et al. 2024

Clinical Kidney Journal

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Background While SARS-CoV-2 infection has direct obvious consequences on patients undergoing dialysis, the COVID-19 pandemic also had an indirect impact on health systems. Therefore, we aimed to determine whether the COVID-19 era itself was associated with adverse consequences in the Swiss dialysis population as compared to the pre-COVID-19 era, while accounting for direct impact of SARS-CoV-2 infection. Methods We retrospectively included all patients recorded in the Swiss dialysis registry from January 2014 to December 2022. The pre-COVID-19 era and the COVID-19 era were defined based on the cut-off date of January 2020. Cox proportional hazard model was used with all-cause mortality as the primary outcome. Results The cohort consisted of 7′837 patients from 97 dialysis centres. Median age was 68.6 years with 66.1% men. Crude mortality rates were 11.6% (11.0% to 12.2%) and 14.2% (13.4% to 14.9%) person-years for the pre-COVID-19 era and the COVID-19 era, respectively. In multivariable analysis, SARS-CoV-2 infection was associated with an increased risk of mortality (HR 4.26, 95% CI 3.65 to 4.97, P < 0.001) while the COVID-19 era itself was not (HR 0.98, 95% CI 0.88 to 1.08, P = 0.687). Conclusions The COVID-19 era was not associated with an excess of mortality in the Swiss dialysis population as compared to the pre-COVID-19 era when accounting for the direct effect of SARS-CoV-2 infection. This suggests that control measures established during the pandemic did not have a negative impact on dialysis patients at the national level. These results could inform health policy makers in the eventuality of future pandemics.

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Comparison of nutritional and hydration status in patients undergoing twice and thrice-weekly hemodialysis: a silent drama in developing countries

Cited by 3 publications

References 44 publications

Impact of incremental initiation of haemodialysis on mortality: a systematic review and meta-analysis

Impact of incremental initiation of haemodialysis on mortality: a systematic review and meta-analysis

Incremental versus conventional haemodialysis in end-stage kidney disease: a systematic review and meta-analysis

Mortality associated with the COVID-19 pandemic in the Swiss dialysis population beyond SARS-CoV-2 infection

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