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Incremental Hemodialysis: The University of California Irvine Experience
Mehrdad Ghahremani-Ghajar1, Vanessa Rojas-Bautista1, Wei-Ling Lau1
1Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California.
Insights
Incremental hemodialysis, starting twice-weekly, may preserve residual kidney function (RKF) in end-stage renal disease (ESRD) patients. This approach shows promise for improving survival and quality of life in early dialysis stages.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Dialysis Management
Background:
- Preserving residual kidney function (RKF) is crucial for end-stage renal disease (ESRD) patient survival and quality of life.
- Clinical guidelines support incremental dialysis initiation for peritoneal dialysis patients with substantial RKF.
- Limited guidance exists for incremental hemodialysis as an initial renal replacement therapy.
Purpose of the Study:
- To describe a case series of incident ESRD patients initiating an incremental hemodialysis program.
- To compare outcomes for patients maintaining a twice-weekly schedule versus those transitioning to thrice-weekly hemodialysis.
- To provide a template for implementing incremental hemodialysis in North America.
Main Methods:
- Case series of 13 ambulatory incident ESRD patients.
- Enrollment in an Incremental Hemodialysis Program from January 2015 to August 2016.
- Follow-up through December 2016, comparing twice-weekly (n=5) versus thrice-weekly (n=8) schedules.
Main Results:
- Description of longitudinal case-mix, laboratory, and dialysis treatment characteristics.
- Comparison between patients on sustained twice-weekly versus transitioned thrice-weekly hemodialysis.
- The University of California Irvine Experience represents the first systematic examination of twice-weekly hemodialysis in North America.
Conclusions:
- Incremental hemodialysis is a potentially viable initial regimen for selected ESRD patients with substantial RKF.
- This case series provides initial insights into twice-weekly hemodialysis practices.
- Further research is needed to optimize approaches and identify ideal patient populations for incremental hemodialysis.
Abstract:
Incremental hemodialysis has been examined as a viable hemodialysis regimen for selected end-stage renal disease (ESRD) patients. Preservation of residual kidney function (RKF) has been the driving impetus for this approach given its benefits upon the survival and quality of life of dialysis patients. While clinical practice guidelines recommend an incremental start of dialysis in peritoneal dialysis patients with substantial RKF, there remains little guidance with respect to incremental hemodialysis as an initial renal replacement therapy regimen. Indeed, several large population-based studies suggest that incremental twice-weekly vs. conventional thrice-weekly hemodialysis has favorable impact upon RKF trajectory and survival among patients with adequate renal urea clearance and/or urine output. In this report, we describe a case series of 13 ambulatory incident ESRD patients enrolled in a university-based center's Incremental Hemodialysis Program over the period of January 2015 to August 2016 and followed through December 2016. Among five patients who maintained a twice-weekly hemodialysis schedule vs. eight patients who transitioned to thrice-weekly hemodialysis, we describe and compare patients' longitudinal case-mix, laboratory, and dialysis treatment characteristics over time. The University of California Irvine Experience is the first systemically examined twice-weekly hemodialysis practice in North America. While future studies are needed to refine the optimal approaches and the ideal patient population for implementation of incremental hemodialysis, our case-series serves as a first report of this innovative management strategy among incident ESRD patients with substantial RKF, and a template for implementation of this regimen.
