Gradual initiation of dialysis as a means to reduce cost while providing quality health care

Elrggal, Mohamed E; Zyada, Rowan

doi:10.1038/nrneph.2017.135

Cited by 4 publications

(4 citation statements)

References 12 publications

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“…Effect of infectious complications' minimization or cardiovascular event prevention, on patient survival is suggested by others [ 31 ]; in this study, a number of infectious complications or cardiovascular events culminating to death were numerically, but not statistically, more in undocumented, uninsured, Afghan patients, and this may be due to the small sample size, that is one of our study's limitations. Some researchers have recommended gradual, incremental, or twice weekly hemodialysis for overcoming resource constraints with no effect on the quality of care [ 32 – 34 ]; we were not able to test these options in this study. However, the final word and important limitation of study may be that the present study is not able to establish a direct correlation between hemodialysis inadequacy and survival because lack of insurance and funding, resulting in health disparity, may have deeply impacted other aspects of these patients' health care, thus resulting in lower survival.…”

Section: Discussionmentioning

confidence: 96%

Hemodialysis Adequacy and Its Impact on Long-Term Patient Survival in Demographically, Socially, and Culturally Homogeneous Patients

Hekmat

2020

International Journal of Nephrology

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Background. Impact of hemodialysis adequacy on patient survival is extensively studied. The current study compares the survival of chronic hemodialyzed, undocumented, uninsured, Afghan immigrant patients with that of a group of insured Iranian patients matched for underlying disease, age, weight, level of education, marital status, income, and number of comorbid conditions. Methods. Eighty chronic hemodialysis patients (mean age 42.8 ± 10.5 years) entered this historical cohort study in Mashhad, Iran, between January 2012 and January 2015. Half of the patients were undocumented, uninsured, Afghan immigrants (Group A) matched with forty insured Iranian patients (Group B). To compare the survival rate of the two patient groups, Kaplan–Meir survival analysis test was used. Results. Group A patients were underdialyzed with a weekly Kt/V which was significantly less in comparison with that of Group B (1.63 ± 0.63 versus 2.54 ± 0.12, p value = 0.01). While Group A’s number of hemodialysis sessions per week was fewer than that of Group B (1.45 ± 0.56 versus 2.8 ± 0.41, p value = 0.04), the mean of Kt/V in each hemodialysis session was higher in them, in comparison with Group B (1.43 ± 0.25 versus 1.3 ± 0.07, p value = 0.045). In Group B and Group A patients, one-year survival was 70% versus 50%, two-year survival was 55% versus 30%, and three-year survival was 40% versus 20%, respectively (p values = 0.04, 0.02 and 0.04, respectively). In Cox regression analysis, hemodialysis adequacy and uninsurance were factors impacting patients’ survival (OR = 1.193 and 0.333, respectively). Conclusions. Undocumented, uninsured, inadequately hemodialyzed, Afghan patients had a significantly lower one-, two-, and three-year survival as opposed to their Iranian counterparts, probably due to lack of insurance.

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Section: Discussionmentioning

confidence: 96%

Hemodialysis Adequacy and Its Impact on Long-Term Patient Survival in Demographically, Socially, and Culturally Homogeneous Patients

Hekmat

2020

International Journal of Nephrology

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“…In China, it was estimated in 2013 that about 26% of Patterns Study countries, the quality of life was similar between patients on twice weekly dialysis to those on a three times weekly schedule [6]. In Egypt, like many other counties, incremental dialysis is an evolving practice that still needs verification through randomized controlled trials [7]. Unsurprisingly, no specific guideline addresses the appropriate timing and dose of incremental dialysis or selection criteria other than residual kidney function.…”

mentioning

confidence: 99%

“…In Egypt, like many other counties, incremental dialysis is an evolving practice that still needs verification through randomized controlled trials [ 7 ]. Unsurprisingly, no specific guideline addresses the appropriate timing and dose of incremental dialysis or selection criteria other than residual kidney function.…”

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confidence: 99%

Individualizing dialysis dose under certain circumstances during the Severe Acute Respiratory Syndrome Coronavirus-2 (coronavirus disease 2019) pandemic: a perspective

Abdelaziz

2020

Kidney Res Clin Pract

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“…uraemic symptoms, refractory fluid overload, poor solute clearances, etc.). Apart from potential benefits to preserving residual kidney function, incremental dialysis may offer considerable cost savings, and is likely to be palatable to most patients if it offers comparable outcomes with a lesser burden of time spent on dialysis.…”

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confidence: 99%

Incremental and twice weekly haemodialysis in Australia and New Zealand

et al. 2019

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Background Haemodialysis is usually started at a frequency of three times a week, with occasional patients starting twice weekly (‘incremental dialysis’). Incremental haemodialysis (HD) may preserve residual kidney function and has been associated with reduced mortality. In the present study, we report prevalence and outcomes of incremental dialysis in Australia and New Zealand. Methods The cohort was all adults starting renal replacement therapy with HD in Australia and New Zealand 2004–2015. We used cox proportional hazards modelling with a primary exposure of dialysis frequency at first survey date (≥ or <3 times per week). The primary outcome was all‐cause mortality (primary), cardiovascular and non‐cardiovascular mortality (secondary). Results Eight‐hundred fifty of 27 513 subjects were started on twice weekly HD (prevalence 3%). Compared to conventional patients, incremental dialysis patients were older (67 vs 62 years, P < 0.001), had a lower body mass index (26.1 vs 27.7 kg/m2, P < 0.001), had a higher starting estimated glomerular filtration rate (7.59 vs 6.66 mL/min P < 0.001) and had less diabetes (39.2% vs 50.2%, P < 0.001). In a multivariate model, incremental start dialysis was not associated with all‐cause mortality (hazard ratio (HR) = 1.03, 95% confidence interval (CI) = 0.92–1.16) or cardiovascular mortality (HR = 0.87, 95% CI = 0.71–1.07), but was associated with an increased risk of non‐cardiovascular mortality (HR = 1.25, 95% CI = 1.11–1.42). Conclusion Incremental dialysis was used infrequently, and there was evidence of patient level differences. All‐cause mortality was similar, but there were differences in cause specific mortality. Incremental dialysis needs to be tested in prospective trials to define the safety and efficacy of this approach.

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Gradual initiation of dialysis as a means to reduce cost while providing quality health care

Abstract: We read with interest the comprehensive Review by R. Vanholder et al. (Reducing the costs of chronic kidney disease while delivering quality health care: a call to action. Nat. Rev. Nephrol. 13, 393-409;

Cited by 4 publications

References 12 publications

Hemodialysis Adequacy and Its Impact on Long-Term Patient Survival in Demographically, Socially, and Culturally Homogeneous Patients

Hemodialysis Adequacy and Its Impact on Long-Term Patient Survival in Demographically, Socially, and Culturally Homogeneous Patients

Individualizing dialysis dose under certain circumstances during the Severe Acute Respiratory Syndrome Coronavirus-2 (coronavirus disease 2019) pandemic: a perspective

Incremental and twice weekly haemodialysis in Australia and New Zealand

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