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Related Concept Videos

Dialysis01:27

Dialysis

294
Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
294

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A practical approach to implementing incremental haemodialysis.

Usama Butt1, A Davenport2,3, S Sridharan4,5

  • 1Renal Unit, Lister Hospital, East and North Herts NHS Trust, Hertfordshire, SG1 4AB, UK. usama.butt1@nhs.net.

Journal of Nephrology
|May 19, 2024
PubMed
Summary
This summary is machine-generated.

Starting haemodialysis (HD) incrementally, considering residual kidney function (RKF), may improve patient well-being and reduce costs. This approach requires careful patient selection and RKF assessment for successful implementation.

Keywords:
DialysisGuideHemodialysisIncrementalIndividualizationPractical

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Area of Science:

  • Nephrology
  • Renal Medicine

Background:

  • End-stage kidney disease (ESKD) patients often start haemodialysis (HD), facing significant challenges and high early mortality.
  • Intensive HD regimens are suspected contributors to poor initial outcomes.
  • An incremental HD approach, utilizing residual kidney function (RKF), offers a gentler start with adjustable intensity.

Purpose of the Study:

  • To explore the benefits of an incremental haemodialysis approach.
  • To address physician concerns regarding incremental HD adoption.
  • To provide guidance on patient selection and RKF assessment for incremental HD.

Main Methods:

  • Review of observational studies and ongoing randomized controlled trials comparing incremental vs. conventional HD.
  • Discussion of methods for estimating RKF and adjusting dialysis intensity.
  • Guidance on patient selection criteria, including residual urea clearance thresholds.

Main Results:

  • Observational studies suggest incremental HD improves quality of life and reduces costs.
  • Randomized trials are investigating its efficacy against standard thrice-weekly HD.
  • Key challenges include physician concerns about dialysis adequacy and practical RKF estimation.

Conclusions:

  • Incremental HD, tailored to RKF, shows promise for better patient outcomes and cost-effectiveness.
  • Overcoming implementation challenges through clear guidelines is crucial for wider adoption.
  • Careful patient selection and precise RKF monitoring are fundamental to successful incremental HD programs.