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Increasing Haemodialytic Clearances as Residual Renal Function Declines: An Incremental Approach
Kamonwan Tangvoraphonkchai1, Andrew Davenport
1Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand.
Blood Purification
|August 16, 2017
Summary
Preserving residual renal function (RRF) in chronic kidney disease patients improves outcomes and survival. An incremental approach to hemodialysis (HD), starting with less frequent sessions, may better preserve RRF.
Area of Science:
- Nephrology
- Renal Replacement Therapy
Background:
- Chronic kidney disease (CKD) patients often initiate thrice-weekly hemodialysis (HD) targeting urea clearance.
- Increasing HD urea clearance above 1.2 has not improved survival.
- Preservation of residual renal function (RRF) is linked to better patient outcomes and survival.
Purpose of the Study:
- To explore the benefits of preserving RRF in CKD patients undergoing HD.
- To evaluate the impact of different HD initiation strategies on RRF preservation.
- To introduce the concept of incremental dialysis for managing RRF.
Main Methods:
- Review of observational studies on HD initiation and RRF.
- Analysis of the relationship between HD frequency and RRF preservation.
- Concept development for incremental dialysis based on RRF assessment.
Main Results:
- Higher sessional dialyzer urea clearance above 1.2 does not enhance patient survival.
- Preserving RRF is associated with improved self-reported outcomes and survival.
- Twice-weekly HD schedules may lead to greater RRF preservation compared to thrice-weekly.
Conclusions:
- An incremental approach to initiating HD, tailored to decreasing RRF, is proposed.
- Regular RRF assessment is crucial for effective incremental dialysis practice.
- Adjusting HD schedule and modality is necessary upon RRF loss to optimize toxin clearance.
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