Impact of hemodialysis dose and frequency on survival of patients on chronic hemodialysis in Lithuania during 1998–2005

Stankuvienė, Asta; Žiginskienė, Edita; Kuzminskis, Vytautas; Bumblytė, Inga Arūnė

doi:10.3390/medicina46080074

Cited by 37 publications

(25 citation statements)

References 14 publications

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“…Nonetheless, this study underscores the potential risks of twice‐weekly dialysis in patients with minimal RKF. This is consistent with other studies showing increased mortality with twice‐weekly dialysis when RKF is not incorporated into the prescription …”

Section: Rkf Measurementsupporting

confidence: 93%

The importance of residual kidney function in haemodialysis patients

2018

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In contrast to peritoneal dialysis, residual kidney function (RKF) is commonly disregarded for haemodialysis (HD) patients and not regularly monitored or taken into account in routine clinical care. This is despite evidence that higher levels of RKF in HD patients are associated with better outcomes, including survival, total solute clearance, nutrition, inflammation and fluid balance. This review aims to summarise the clinical effects of RKF specifically in HD patients. Some level of RKF is present in over 80% of patients at the time of dialysis initiation, and while this declines over time, up to 30% of patients on HD for 5 years still have a measurable level of native kidney function. There is little evidence on how best to preserve RKF in HD patients, although it has been observed that intensive HD regimens in incident HD patients appear to accelerate RKF decline. RKF is not commonly factored into HD prescription and measures of adequacy, despite the fact that some guidelines such as Kidney Disease Outcomes Quality Initiative (KDOQI) and European Best Practice Guidelines suggest that it is reasonable to do so. This likely relates, at least in part, to perceived concerns regarding the inconvenience of timed urine collections and to the complexity and lack of consensus regarding the methods for integrating the intermittent clearance of HD with the continuous clearance of native renal function. Further research is required into how best to maintain and maximise the benefits of RKF in HD patients.

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Section: Rkf Measurementsupporting

confidence: 93%

The importance of residual kidney function in haemodialysis patients

2018

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“…On the other hand, several contradictory studies indicated that patients on thrice‐weekly HD had a better survival than those on twice‐weekly dialysis (). In an observational study of 2428 patients, less frequent HD was associated with shorter patient survival; weekly treatment time of less than 8 hours was an independent risk factor (). Interestingly, the author did not provide a relative risk analysis for the 12 hours threshold which was considered as the standard weekly duration for thrice‐weekly HD.…”

Section: Effect Of Twice‐weekly Dialysis On Mortalitymentioning

confidence: 99%

Twice‐Weekly Hemodialysis in China: Can It Be A Better Option for Initiation or Maintenance Dialysis Therapy?

Yan¹,

Ramirez²,

Anand

et al. 2017

Seminars in Dialysis

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Cumulative evidence indicates it may be worthwhile revisiting the twice-weekly hemodialysis (HD) regimen as a valid option for individualized or incremental treatments for selected patients with end-stage renal disease. In this article, we will review the current evidences on the potential pros and cons of twice-weekly HD compared to thrice-weekly HD including China’s experience in the practice of twice-weekly HD. A prudent patient selection and close dialysis adequacy monitoring might be necessary for this medical treatment choice. More randomized prospective controlled studies for the critical evaluation of twice-weekly dialysis are encouraged.

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“…Similarly, the US Registry data from 1999 (42) reported a survival advantage for twice-weekly hemodialysis, but again, the twice-weekly group had greater RRF. On the other hand, studies from Sudan and Lithuania reported lower survival with less frequent HD (43,44). This could be explained by observations in a recent US cohort which showed that the higher mortality in twice-weekly HD was limited to patient with inadequate RRF (45).…”

Section: Patient Survivalmentioning

confidence: 99%

Incremental Hemodialysis – A European Perspective

Tangvoraphonkchai

Davenport

2017

Seminars in Dialysis

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Most patients initiating hemodialysis have residual renal function (RRF). Whereas RRF is monitored prior to commencing hemodialysis, once dialysis is started most centres simply rely on dialyzer urea clearance to determine adequate uremic toxin clearance and disregard the effect of RRF. However sustaining RRF is important for the dialysis patient, as RRF reduces inter-dialytic weight gains, increases middle molecule and protein bound toxin clearances and is associated with better quality of life assessments. Paradoxically, more frequent dialysis and longer dialysis sessions appear to be associated with more rapid loss of RRF. As such, starting patients with less frequent or shorter dialysis sessions, depending upon individual patient comorbidity, may lead to better preservation of RRF. However to prevent inadequate uremic toxin clearance or volume overload, RRF needs to be regularly monitored. Unfortunately, the 24-hour urine collection for urea and creatinine clearance remains the mainstay for RRF assessment. This measurement chiefly represents glomerular clearance rather than tubular function, but the latter may be also important for the dialysis patients. Incremental dialysis with less initial dialysis treatment may lower costs and will allow others to dialyze more frequently. The key to start a successful incremental hemodialysis approach is the regular monitoring of the patient, so that as RRF is lost an appropriate decision can be made regarding increasing dialysis session duration and frequency on an individual patient basis or consider switching modalities to hemodiafiltration.

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Impact of hemodialysis dose and frequency on survival of patients on chronic hemodialysis in Lithuania during 1998–2005

Abstract: Summary. Introduction. The question of the targets of dialysis dosing remains controversial since the beginning of the long-term dialysis treatment era. It is still uncertain if higher dialysis

Cited by 37 publications

References 14 publications

The importance of residual kidney function in haemodialysis patients

The importance of residual kidney function in haemodialysis patients

Twice‐Weekly Hemodialysis in China: Can It Be A Better Option for Initiation or Maintenance Dialysis Therapy?

Incremental Hemodialysis – A European Perspective

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