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Incremental Hemodialysis: The University of California Irvine Experience
Author(s) -
GhahremaniGhajar Mehrdad,
RojasBautista Vanessa,
Lau WeiLing,
Pahl Madeleine,
Hernandez Miguel,
Jin Anna,
Reddy Uttam,
Chou Jason,
Obi Yoshitsugu,
KalantarZadeh Kamyar,
Rhee Connie M.
Publication year - 2017
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12591
Subject(s) - medicine , hemodialysis , dialysis , population , renal replacement therapy , regimen , end stage renal disease , intensive care medicine , dialysis adequacy , home hemodialysis , peritoneal dialysis , surgery , environmental health
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.