Incremental and Personalized Hemodialysis Start: A New Standard of Care

Torreggiani, Massimo; Fois, Antioco; Chatrenet, Antoine; Nielsen, Louise; Gendrot, Lurlynis; Longhitano, Elisa; Lecointre, Léna; García, C. Villares; Breuer, Conrad; Mazé, Béatrice; Hami, Assia; Séret, Guillaume; Saulniers, Patrick; Ronco, Pierre; Lavainne, Frédéric; Piccoli, Giorgina Barbara

doi:10.1016/j.ekir.2022.02.010

Cited by 25 publications

(16 citation statements)

References 65 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 ]. The majority of studies ( n = 16) were multicentre studies [ 18 , 22–24 , 26 , 28 , 29 , 31–36 , 38–40 ], including those utilizing national cohort data.…”

Section: Resultsmentioning

confidence: 99%

“…All studies included in the review defined conventional HD as a prescription of at least three sessions of HD per week, with two studies also including patients receiving more than three sessions per week [ 37 , 39 ]. In 19 studies, incremental HD referred to a prescription of two HD session per week [ 4 , 6 , 17 , 20 , 22–28 , 30–35 , 38 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

“…In 19 studies, incremental HD referred to a prescription of two HD session per week [ 4 , 6 , 17 , 20 , 22–28 , 30–35 , 38 , 40 ]. Six studies defined incremental dialysis as receiving either one or two sessions [ 19 , 21 , 29 , 36 , 37 , 39 ], and in Caria et al . [ 18 ], the intervention group received one session of HD per week in combination with a very low protein diet.…”

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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“…In a recent publication, Torreggianni et al. [ 29 ] compared 53 patients starting dialysis with TW-HD with 91 patients initiating with I-HD. While the mean duration of I-HD to TW-HD transition was not provided, the rate of persistence on I-HD at 1 year was around 50%.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of incident patients treated with incremental haemodialysis as compared with standard haemodialysis and peritoneal dialysis

Jaques

Ponte

Haidar

et al. 2022

Nephrology Dialysis Transplantation

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Background Residual kidney function is considered better preserved with incremental haemodialysis (I-HD) or peritoneal dialysis (PD) as compared with conventional thrice-weekly HD (TW-HD) and is associated with improved survival. We aimed to describe outcomes of patients initiating dialysis with I-HD, TW-HD or PD. Methods We conducted a retrospective analysis of a prospectively assembled cohort in a single university centre including all adults initiating dialysis from January 2013 to December 2020. Primary and secondary endpoints were overall survival and hospitalization days at 1 year, respectively. Results We included 313 patients with 234 starting on HD (166 TW-HD and 68 I-HD) and 79 on PD. At the end of the study, 10 were still on I-HD while 45 transitioned to TW-HD after a mean duration of 9.8 ± 9.1 months. Patients who stayed on I-HD were less frequently diabetics (P = .007). Mean follow-up was 33.1 ± 30.8 months during which 124 (39.6%) patients died. Compared with patients on TW-HD, those on I-HD had improved survival (hazard ratio 0.49, 95% confidence interval 0.26-0.93, P = .029), while those on PD had similar survival. Initial kidney replacement therapy modality was not significantly associated with hospitalization days at 1 year. Conclusions I-HD is suitable for selected patients starting dialysis and can be maintained for a significant amount of time before transition to TW-HD, with diabetes being a risk factor. Although hospitalization days at 1 year are similar, initiation with I-HD is associated with improved survival as compared with TW-HD or PD. Results of randomized controlled trials are awaited prior to large-scale implementation of I-HD programmes.

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“… 4 In a paper published in this issue of KI Reports , Torreggiani et al. 5 report their findings regarding incremental HD (iHD) where the approach was standardized to provide sufficient dialytic clearance of uremic solutes and appropriate volume control coupled with escalation of dose frequency as needed determined by clinical assessment.…”

mentioning

confidence: 99%

Is It Time to Reconsider How We Initiate Maintenance Dialysis?

Mendez

2022

Kidney International Reports

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Incremental and Personalized Hemodialysis Start: A New Standard of Care

Cited by 25 publications

References 65 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

Outcomes of incident patients treated with incremental haemodialysis as compared with standard haemodialysis and peritoneal dialysis

Is It Time to Reconsider How We Initiate Maintenance Dialysis?

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