Temporal trends in fluid management with incremental hemodialysis


Area of Science:

• Nephrology
• Internal Medicine
• Clinical Research

Background:

• Incremental hemodialysis (HD) is rarely used in the United States.
• This study examines volume management changes in patients with incident end-stage kidney disease (ESKD) transitioning from bi-weekly to thrice-weekly HD.

Purpose of the Study:

• To describe longitudinal changes in interdialytic weight gain (IDWG) and ultrafiltration rate (UFR) in ESKD patients.
• To evaluate fluid management during the transition from bi-weekly to thrice-weekly HD.

Main Methods:

• 23 patients with incident ESKD were analyzed.
• Repeated measures regression assessed IDWG and UFR across three dialysis periods.
• Periods included: first 3 months of bi-weekly HD, last 3 months of bi-weekly HD, and first 3 months of thrice-weekly HD.

Main Results:

• IDWG and UFR increased significantly in the last 3 months of bi-weekly HD and the first 3 months of thrice-weekly HD compared to the initial period.
• The proportion of patients with IDWG > 5.7% increased from 0% to 12% during bi-weekly HD.
• The proportion of patients with UFR > 10 mL/kg/h increased from 16% to 39% during bi-weekly HD.

Conclusions:

• Fluid management deteriorates in incident ESKD patients on bi-weekly HD before conversion to thrice-weekly HD.
• Further research is necessary to optimize incremental HD prescriptions for better volume control.