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Related Concept Videos

Dialysis01:27

Dialysis

277
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...
277
Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

69
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
69
Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

352
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
352
Factors Affecting Renal Clearance: Renal Impairment01:17

Factors Affecting Renal Clearance: Renal Impairment

62
Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
62
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

404
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
404

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Reduced intensity incremental hemodialysis start does not decrease life expectancy and saves money: results of the

Andrea Campo1, Franco Goia2, Roberto Cottino2

  • 1SC Nefrologia e Dialisi, Osp S. Lazzaro, Alba, CN, Italy. andrea_campo@hotmail.com.

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Summary

Twice-weekly hemodialysis is a safe and cost-effective approach for initiating treatment in patients with residual kidney function. This method preserves kidney function and reduces hospital admissions, demonstrating its feasibility under strict clinical surveillance.

Keywords:
Cost savingHospitalisationIncremental HaemodialysisResidual kidney function

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Area of Science:

  • Nephrology
  • Renal Replacement Therapy
  • Public Health

Background:

  • Twice-weekly hemodialysis has been the standard for initiating hemodialysis at Alba Hospital since 2001.
  • This study evaluates its long-term impact on patient outcomes and healthcare costs.

Purpose of the Study:

  • To assess the safety, feasibility, and cost-effectiveness of twice-weekly hemodialysis for incident hemodialysis patients with residual kidney function.
  • To compare outcomes between patients with long-term versus short-term twice-weekly hemodialysis durations.

Main Methods:

  • Incident hemodialysis patients with residual kidney function (urine output > 500 ml/day) were selected from January 2001 to December 2016.
  • Patients were followed until death or December 31, 2019, with endpoints including survival, hemodialysis duration, residual kidney function preservation, and cost savings.
  • Subgroup analysis compared long-term (≥365 days) and short-term (<365 days) twice-weekly hemodialysis durations, matched for key demographic and clinical factors.

Main Results:

  • The study included 146 patients; median survival was 1793 days, and median residual kidney function duration was 820 days.
  • Long-term twice-weekly hemodialysis was associated with lower hospital admissions and unscheduled dialysis rates, and better residual kidney function preservation (1353 vs 445 days).
  • A cost saving of €1,986,226 was achieved by sparing 12,291 hemodialysis sessions.

Conclusions:

  • Twice-weekly hemodialysis is a safe, feasible, and cost-saving method for initiating hemodialysis in patients with residual kidney function.
  • Strict clinical surveillance is essential for the successful implementation of this approach.
  • This strategy contributes to preserving residual kidney function and reducing healthcare expenditures.