What Is Known and Unknown About Twice-Weekly Hemodialysis

Obi, Yoshitsugu; Eriguchi, Rieko; Ou, Shuo‐Ming; Rhee, Connie M.; Kalantar-Zadeh, Kamyar

doi:10.1159/000441577

Cited by 34 publications

(31 citation statements)

References 40 publications

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“…In conclusion, our study examines associations between HD treatment frequency and patient survival. In agreement with recent literature, 30,31 our findings suggest that in an incident HD population, certain selected patients with adequate RKF, adequate control of interdialytic weight gain, and low or moderate comorbid disease burden (CCI <5), an incremental HD approach may be considered a suitable alternative to conventional thrice-weekly HD. However, further studies, including prospective and randomized, controlled trials, are warranted to clarify the impact of incremental HD on safety and quality of life in incident HD patients and to identify patients who would benefit from incremental HD before an incremental approach to HD initiation can be recommended for routine clinical practice.…”

Section: Discussionsupporting

confidence: 92%

Treatment frequency and mortality among incident hemodialysis patients in the United States comparing incremental with standard and more frequent dialysis

Mathew

Obi

Rhee

et al. 2016

Kidney International

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Section: Discussionsupporting

confidence: 92%

Treatment frequency and mortality among incident hemodialysis patients in the United States comparing incremental with standard and more frequent dialysis

Mathew

Obi

Rhee

et al. 2016

Kidney International

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“…1,2,9 However, with a regular dialysis dose of single-pool Kt/V 1.2, a KRU level >3 mL/min/1.73m 2 would be required to meet the minimum standard Kt/V with twice-weekly hemodialysis. 28 Our subgroup analyses provide additional evidence that patients who have substantial RKF (KRU ≥3 mL/min/1.73m 2 or UV ≥600 mL/day) may safely initiate twice-weekly hemodialysis upon their transition to renal replacement therapy. Our study also suggested the potential harm of twice-weekly hemodialysis for patients with little or no RKF.…”

Section: Discussionmentioning

confidence: 75%

“…The benefit versus harm of twice-weekly hemodialysis may depend on patients’ RKF while other factors including comorbidities, life expectancy, medication adherence, medical resources, and dietary intake may also play roles. 28 …”

Section: Discussionmentioning

confidence: 99%

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Incremental Hemodialysis, Residual Kidney Function, and Mortality Risk in Incident Dialysis Patients: A Cohort Study

Obi

Streja

Rhee

et al. 2016

American Journal of Kidney Diseases

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204

217

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Background Maintenance hemodialysis is typically prescribed thrice-weekly irrespective of patient's residual kidney function (RKF). We hypothesized that a less frequent schedule at hemodialysis initiation is associated with greater preservation of RKF without compromising survival among patients with substantial RKF. Study Design A longitudinal cohort Setting & Participants 23,645 patients who initiated maintenance hemodialysis in a large dialysis organization in the United States (1/2007–12/2010), who had available RKF data during the first 91 days (or quarter) of dialysis, and who survived the first year. Predictor Incremental (routine twice-weekly for >6 continuous weeks during the first 91 days upon transition to dialysis) versus conventional (thrice-weekly) hemodialysis regimens during the same time. Outcomes Changes in renal urea clearance (KRU) and urine volume (UV) during one year after the first quarter, and survival after the first year. Results Among 23,645 included patients, 51% had substantial KRU (≥3.0 mL/min/1.73m2) at baseline. Compared to 8,068 patients with conventional hemodialysis regimen matched based on baseline KRU, UV, age, gender, diabetes, and central venous catheter use, 351 patients with incremental regimen exhibited 16% (95% CI, 5%-28%) and 15% (95% CI, 2%-30%) more preserved KRU and UV at second quarter, respectively, which remained across the following quarters. Incremental regimen showed higher mortality risk in patients with inadequate baseline KRU (≤3.0 mL/min/1.73m2; HR, 1.61; 95% CI, 1.07-2.44), but not in those with higher baseline KRU (HR, 0.99; 95% CI, 0.76-1.28). Results were similar in subgroup defined by baseline UV of 600 mL/day. Limitations Potential selection bias and wide CIs. Conclusions Among incident hemodialysis patients with substantial RKF, incremental hemodialysis may be a safe treatment regimen and associated with greater preservation of RKF while higher mortality is observed after a year in those with lowest RKF. Clinical trials are needed to examine safety and effectiveness of twice-weekly hemodialysis.

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“…It has been suggested that in a subset of patients, twice weekly dialysis is optimal, while other study has found that more intensive dialysis is better [33,34]. Our nephrology unit caters patients from distant areas with a span of nearly 150 km and most of the patients are bearing the expenditure of the treatment themselves.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Predictors of Poor Sleep Quality in Patients on Maintenance Hemodialysis

2017

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Purpose Majority of patients on maintenance hemodialysis complain of poor quality of sleep. Earlier studies show controversial findings with regard to the prevalence and predictors of poor quality of sleep in this group. Hence, the present study was planned. Methods Adult subjects undergoing maintenance hemodialysis were included in this study. Their demographic data, history regarding chronic kidney disease, comorbidities, and details related to hemodialysis were recorded. Sleep quality was assessed using Pittsburg Sleep Quality Index. A total of 201 patients were included in this study. Results Average age of the subjects was 54.7 ± 15.1 years and duration of kidney disease was 37.1 ± 19.8 years. 40.3% subjects were women and 50.7% of sample complained of poor quality sleep. Poor sleepers had less than 3/week dialysis (68.6% among poor sleepers vs. 21.2% among good sleepers; P \ 0.001), nighttime dialysis shift (52.9 vs. 20.2% among good sleepers; P \ 0.001), diabetes mellitus (56.9 vs. 39.4% among good sleepers; P = 0.01), and hypnotic use (P \ 0.001). Similarly, subjects with poor sleep quality were older (57.3 ± 14.3 vs. 52.1 ± 15.4 years among good sleepers; P = 0.01). Binomial logistic regression showed that less than thrice a week dialysis and schedule of maintenance hemodialysis predicted the poor sleep quality. Less than 3/week dialysis increased the odds for poor sleep by 6.6 (P \ 0.001) and afternoon and nighttime maintenance hemodialysis shift by 3.2 (P \ 0.001) and 4.6 (P \ 0.001), respectively. Conclusion Poor sleep is a common complaint in patients on hemodialysis. We found that the evening or night shift of hemodialysis and twice weekly hemodialysis worsened the quality of sleep.

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What Is Known and Unknown About Twice-Weekly Hemodialysis

Cited by 34 publications

References 40 publications

Treatment frequency and mortality among incident hemodialysis patients in the United States comparing incremental with standard and more frequent dialysis

Treatment frequency and mortality among incident hemodialysis patients in the United States comparing incremental with standard and more frequent dialysis

Incremental Hemodialysis, Residual Kidney Function, and Mortality Risk in Incident Dialysis Patients: A Cohort Study

Prevalence and Predictors of Poor Sleep Quality in Patients on Maintenance Hemodialysis

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