Prognostic Value of the Delivery Dialysis Dose on Twice-Weekly Hemodialysis Patients

Abstract

Background: Few studies have evaluated the prognostic value of dialysis dose in twice-weekly hemodialysis (HD). A single-pool Kt/V (spKt/V) over 1.70 may benefit patients receiving twice-weekly maintenance HD. Methods: This is a multicenter randomized controlled trial performed on 163 patients from 17 dialysis centers in Shanghai who were allocated to high- (n = 98) and standard-dose groups (n = 65) and followed through 96 weeks of study period. Therapeutic approaches were given to increase spKt/V to over 1.70 in the high-dose group. Data were collected every 12-24 weeks. The primary outcomes were all-cause mortality and major adverse cardio-cerebrovascular events (MACEs) occurrence, and secondary outcomes included residual kidney function (RKF) and health-related quality of life (HR-QOL). Results: The spKt/V in high-dose and standard-dose groups were 1.80 ± 0.23 and 1.55 ± 0.19, respectively, after an 8-week intervention (p < 0.001). At the end of the study, SF-36 physical function and total score in high-dose group were 82 (69-90) and 74 (47-84), respectively, both of which were higher than those in the standard-dose group. Decline in urine volume was observed in both groups with no significant difference (p = 0.431). No difference was found in overall survival between the 2 groups (p = 0.580). The 1-year MACE-free survival for high-dose group was 84.49%, better than 76.72% for standard-dose group (p = 0.029). Conclusions: Higher spKt/V is also associated with MACE-free survival and better HR-QOL, especially in physical function aspect for twice-weekly dialysis patients. Increasing spKt/V over 1.70 in twice-weekly HD population does not cause loss of RKF.

The association between dose of hemodialysis and patients mortality in a prospective cohort study

“…As for CVD mortality, a prospective study from Brazil 27 found that higher hemodialysis dose was not associated with CVD mortality among MHD patients, which was similar with our results. However, there were several previous studies showed that higher Kt/V can reduce CVD mortality in MHD patients 28 , 29 . Bloembergen WE et.al.…”

“…analyzed 2479 MHD patients in America reporting that for each 0.1 higher Kt/V, the death due to cardiac causes was 12% lower 28 .The difference may be due to different races and years of research (1996 versus 2020). Similarly, a prospective randomized controlled study of twice-weekly MHD patients in Shanghai showed that the incidence of CVD in the high-dose group were decreased 29 . The difference may be due to the frequency of dialysis.…”

The strange case of Mr. H. Starting dialysis at 90 years of age: clinical choices impact on ethical decisions

“…If dialysis is highly intrusive in daily life, this is obviously also related to the number of sessions per week. While there is still no agreement on the definition of “incremental” dialysis, some U.S. experts presently suggest an approach based on twice-weekly dialysis [ 18 , 19 , 83 – 85 ]. In Italy, where it is often part of an integrated approach which includes nutritional management, dialysis start generally involves one session per week, while continuing the diet prescribed in the pre-dialysis phase (usually with a moderate protein restriction, at 0.6–0.8 g/Kg/day) [ 18 – 29 , 86 ].…”

“…The slow progression of his chronic kidney disease, with good residual diuresis and lack of life-threatening episodes of ionic derangements (including hyperkalemia) further supported this approach [ 85 – 89 ].…”