Incremental dialysis in ESRD: systematic review and meta-analysis

Garofalo, Carlo; Borrelli, Silvio; Stefano, Toni De; Provenzano, Michele; Andreucci, Michele; Cabiddu, Gianfranca; Milia, Vincenzo La; Vizzardi, Valerio; Sandrini, Massimo; Cancarini, Giovanni; Cupisti, Adamasco; Bellizzi, Vincenzo; Russo, Roberto; Chiodini, Paolo; Minutolo, Roberto; Conte, Giuseppe; Nicola, Luca De

doi:10.1007/s40620-018-00577-9

Cited by 90 publications

(98 citation statements)

References 61 publications

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“…This corresponds to a risk difference of 24% in the cohort predicted to remain free from ESRD over their life‐time. ESRD is associated with a high mortality and therefore preventing CKD progression is expected to result into longer life‐expectancy . This was reflected in the current analysis, where the predicted mean life‐expectancy was extended by 1.72 years on average in the cohort with normokalaemia compared with the cohort with persistent HK.…”

Section: Resultsmentioning

confidence: 62%

“…ESRD is associated with a high mortality and therefore preventing CKD progression is expected to result into longer life-expectancy. 29 This was reflected in the current analysis, where the predicted mean life-expectancy was extended by 1.72 years on average in the cohort with normokalaemia compared with the cohort with persistent HK. Improved survival and less progression to ESRD in patients with normokalaemia explains why CKD pharmaceutical treatment (+€251) and examinations (+€51) components of total cost are higher in this cohort compared with due to longer permanence in CKD health-state.…”

Section: Base-case Analysismentioning

confidence: 63%

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Cost‐analysis of persistent hyperkalaemia in non‐dialysis chronic kidney disease patients under nephrology care in Italy

Provenzano

Francesco²,

Iannazzo³

et al. 2020

Int J Clin Pract

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Aim In patients with chronic kidney disease (CKD), hyperkalaemia (HK) (potassium level ≥ 5.0 mEq/L) is associated with poor clinical outcomes. This study provides novel insights by comparing management costs of CKD patients with normokalaemia vs those with persistent HK regularly followed in renal clinics in Italy. Methods To this aim, a Markov model over life‐time horizon was developed. Time to end‐stage renal disease (ESRD) and time to death in CKD patients were derived from an observational multi‐centre database including 1665 patients with non‐dialysis CKD stage 1‐5 under nephrology care in Italy (15 years follow‐up). Resource use for CKD and HK management was obtained from the observational database, KDIGO international guidelines, and clinical expert opinion. Results Results showed that patients with normokalaemia vs persistent HK brought an average per patient lifetime cost‐saving of €16 059 besides delayed onset of ESRD by 2.29 years and increased survival by 1.79 years with increment in total survival and dialysis‐free survival in normokalaemia that decreased from early to advanced disease. Cost‐saving related to normokalaemia increased at more advanced CKD; however, it was already evident at early stage (3388.97€ at stage 1‐3a). OWSA confirmed cost‐saving associated with normokalaemia across all parameter variations. Discussion and conclusion This model is the first to simulate the impact of HK in non‐dialysis CKD patients on economic and clinical outcomes using real‐world data from nephrology clinics. In these patients, persistent HK results into higher lifetime costs, besides poorer clinical outcomes, that are evident since the early stages of CKD. Maintaining normokalaemia should therefore be of main concern in CKD treatment planning to improve long‐term economic and clinical outcomes.

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Section: Resultsmentioning

confidence: 62%

Section: Base-case Analysismentioning

confidence: 63%

Cost‐analysis of persistent hyperkalaemia in non‐dialysis chronic kidney disease patients under nephrology care in Italy

Provenzano

Francesco²,

Iannazzo³

et al. 2020

Int J Clin Pract

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“…In any case these patient-friendly approaches seem to allow preserving kidney function and lowering dialysis related comorbidity, in particular in association with dietary management [129][130][131][132][133][134][135]. From an ecologic point of view, incremental dialysis allows us to limit the carbon footprint, wastes and social costs, although, almost paradoxically, the treatment costs borne by the institutions providing care may be higher [136].…”

Section: Choice Of Renal Replacement Therapy Has An Ecologic Impactmentioning

confidence: 99%

Green nephrology and eco-dialysis: a position statement by the Italian Society of Nephrology

et al. 2020

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High-technology medicine saves lives and produces waste; this is the case of dialysis. The increasing amounts of waste products can be biologically dangerous in different ways: some represent a direct infectious or toxic danger for other living creatures (potentially contaminated or hazardous waste), while others are harmful for the planet (plastic and non-recycled waste). With the aim of increasing awareness, proposing joint actions and coordinating industrial and social interactions, the Italian Society of Nephrology is presenting this position statement on ways in which the environmental impact of caring for patients with kidney diseases can be reduced. Due to the particular relevance in waste management of dialysis, which produces up to 2 kg of potentially contaminated waste per session and about the same weight of potentially recyclable materials, together with technological waste (dialysis machines), and involves high water and electricity consumption, the position statement mainly focuses on dialysis management, identifying ten first affordable actions: (1) reducing the burden of dialysis (whenever possible adopting an intent to delay strategy, with wide use of incremental schedules); (2) limiting drugs and favouring "natural" medicine focussing on lifestyle and diet; (3) encouraging the reuse of "household" hospital material; (4) recycling paper and glass; (5) recycling non-contaminated plastic; (6) reducing water consumption; (7) reducing energy consumption; (8) introducing environmental-impact criteria in checklists for evaluating dialysis machines and supplies; (9) encouraging well-planned triage of contaminated and non-contaminated materials; (10) demanding planet-friendly approaches in the building of new facilities.

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“…Incremental dialysis, aimed at respecting residual kidney function, and intensive dialysis, aimed at improving efficiency, may be ways to counteract the need for restricted diets, keeping in mind that standard indications apply only to thrice-weekly "conventional" hemodialysis [21][22][23][24][25][26].…”

Section: Lipidsmentioning

confidence: 99%

“…The idea that, in dialysis, "more is better" is not true for fragile patients. The failure of early dialysis start, which was previously considered synonymous with "healthy" dialysis start, to improve patients' prognoses, the recognition of the importance of residual kidney function in determining survival, and the association of the latter with better nutritional status are all elements in favor of a progressive, incremental dialysis start aimed at reducing dialysis-related morbidity and mitigating "dialysis shock" [21][22][23][94][95][96][97][98][99].…”

Section: Concept and Context: A Special Case Incremental Hemodialysismentioning

confidence: 99%

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

et al. 2020

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Dialysis and nutrition are two sides of the same coin—dialysis depurates metabolic waste that is typically produced by food intake. Hence, dietetic restrictions are commonly imposed in order to limit potassium and phosphate and avoid fluid overload. Conversely, malnutrition is a major challenge and, albeit to differing degrees, all nutritional markers are associated with survival. Dialysis-related malnutrition has a multifactorial origin related to uremic syndrome and comorbidities but also to dialysis treatment. Both an insufficient dialysis dose and excessive removal are contributing factors. It is thus not surprising that dialysis alone, without proper nutritional management, often fails to be effective in combatting malnutrition. While composite indexes can be used to identify patients with poor prognosis, none is fully satisfactory, and the definitions of malnutrition and protein energy wasting are still controversial. Furthermore, most nutritional markers and interventions were assessed in hemodialysis patients, while hemodiafiltration and peritoneal dialysis have been less extensively studied. The significant loss of albumin in these two dialysis modalities makes it extremely difficult to interpret common markers and scores. Despite these problems, hemodialysis sessions represent a valuable opportunity to monitor nutritional status and prescribe nutritional interventions, and several approaches have been tried. In this concept paper, we review the current evidence on intradialytic nutrition and propose an algorithm for adapting nutritional interventions to individual patients.

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Incremental dialysis in ESRD: systematic review and meta-analysis

Cited by 90 publications

References 61 publications

Cost‐analysis of persistent hyperkalaemia in non‐dialysis chronic kidney disease patients under nephrology care in Italy

Cost‐analysis of persistent hyperkalaemia in non‐dialysis chronic kidney disease patients under nephrology care in Italy

Green nephrology and eco-dialysis: a position statement by the Italian Society of Nephrology

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

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