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Abstract
Introduction: Incremental or progressive haemodialysis is a modality for starting haemodialysis, based on residual diuresis and adapted to the needs of the patient, and not very widespread despite the potential benefits. For correct follow-up, it is necessary to establish specific guidelines in each haemodialysis session, which must be known by the staff who treat these patients regularly. Aim: To analyse the evolution of patients who start renal replacement therapy with incremental haemodialysis. Material and Method: Retrospective observational study of incident patients on renal replacement therapy using incremental haemodialysis in our centre in the last 10 years. Comparison of baseline and 12-month follow-up results was carried out. Results: In the study period, 49 patients with incremental haemodialysis were included. Although the residual diuresis falls in the first year from 2030±600 ml/day to 1300±500 (p <0.05), in most cases, it remains above one litre. Urea clearance also decreases from 5.7±1.6 ml/min to 3.4±1.6 ml/min per year (p<0.05). Conclusions: Starting renal replacement therapy with incremental haemodialysis can keep residual diuresis longer. Knowledge of the technique and correct handling during dialysis sessions are key.
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References
- Wong J, Vilar E, Davenport A, Farrington K. Incremental haemodialysis. Nephrol Dial Transplant. 2015;30(10):1639-48. DOI: https://doi.org/10.1093/ndt/gfv231
- Selby NM, Kazmi I. Peritoneal dialysis has optimal intradialytic hemodynamics and preserves residual renal function: Why isn’t it better than hemodialysis? Semin Dial. 2019;32(1):3-8. DOI: https://doi.org/10.1111/sdi.12752
- Vilar E, Wellsted D, Chandna SM, Greenwood RN, Farrington K. Residual renal function improves outcome in incremental haemodialysis despite reduced dialysis dose. Nephrol Dial Transplant. 2009;24(8):2502-10. DOI: https://doi.org/10.1093/ndt/gfp071
- Rodríguez-Benítez P, Gómez-Campderá FJ. Importance of the residual renal function in hemodialysis patients. Nefrologia. 2002;22(2):98-103.
- National Kidney Foundation: K/DOQI Clinical Practice Recommendations for Hemodialysis Adequacy. Guideline 6: Preservation of residual kidney function. Am J Kidney Dis 2006;48(Suppl 1):S68-70.
- Kalantar-Zadeh K, Unruh M, Zager PG, Kovesdy CP, Bargman JM, Chen J, et al. Twice-weekly and incremental hemodialysis treatment for initiation of kidney replacement therapy. Am J Kidney Dis. 2014;64(2):181-6. DOI: https://doi.org/10.1053/j.ajkd.2014.04.019
- Vanholder R, Van Biesen W, Lameire N. Is starting hemodialysis on a twice-weekly regimen a valid option? Am J Kidney Dis. 2014;64(2):165-7. DOI: https://doi.org/10.1053/j.ajkd.2014.06.003
- Chin AI, Appasamy S, Carey RJ, Madan N. Feasibility of Incremental 2-Times Weekly Hemodialysis in Incident Patients With Residual Kidney Function. Kidney Int Rep. 2017;2(5):933-42. DOI: https://doi.org/10.1016/j.ekir.2017.06.005
- Nongnuch A, Assanatham M, Panorchan K, Davenport A. Strategies for preserving residual renal function in peritoneal dialysis patients. Clin Kidney J. 2015;8(2):202-11. DOI: https://doi.org/10.1093/ckj/sfu140
- Liu Y, Zou W, Wu J, Liu L, He Q. Comparison between incremental and thrice-weekly haemodialysis: Systematic review and meta-analysis. Nephrology (Carlton). 2019;24(4):438-44. DOI: https://doi.org/10.1111/nep.13252
- Kuipers J, Oosterhuis JK, Krijnen WP, Dasselaar JJ, Gaillard CA, et al. Prevalence of intradialytic hypotension, clinical symptoms and nursing interventions--a three-months, prospective study of 3818 haemodialysis sessions. BMC Nephrol. 2016;17:21. DOI: https://doi.org/10.1186/s12882-016-0231-9
- Zhang M, Wang M, Li H, Yu P, Yuan L, Hao C, et al. Association of Initial Twice-Weekly Hemodialysis Treatment with Preservation of Residual Kidney Function in ESRD Patients. Am J Nephrol. 2014;40(2):140-50. DOI: https://doi.org/10.1159/000365819
- Fernández-Lucas M, Teruel-Briones JL, Gomis-Couto A, Villacorta-Pérez J, Quereda-Rodríguez-Navarro C. Maintaining residual renal function in patients on haemodialysis: 5-year experience using a progressively increasing dialysis regimen. Nefrologia. 2012;32(6):767-76.
- Lin YF, Huang JW, Wu MS, Chu TS, Lin SL, Chen YM, et al. Comparison of residual renal function in patients undergoing twice-weekly versus three-times-weekly haemodialysis. Nephrology (Carlton). 2009;14(1):59-64. DOI: https://doi.org/10.1111/j.1440-1797.2008.01016.x
References
Wong J, Vilar E, Davenport A, Farrington K. Incremental haemodialysis. Nephrol Dial Transplant. 2015;30(10):1639-48. DOI: https://doi.org/10.1093/ndt/gfv231
Selby NM, Kazmi I. Peritoneal dialysis has optimal intradialytic hemodynamics and preserves residual renal function: Why isn’t it better than hemodialysis? Semin Dial. 2019;32(1):3-8. DOI: https://doi.org/10.1111/sdi.12752
Vilar E, Wellsted D, Chandna SM, Greenwood RN, Farrington K. Residual renal function improves outcome in incremental haemodialysis despite reduced dialysis dose. Nephrol Dial Transplant. 2009;24(8):2502-10. DOI: https://doi.org/10.1093/ndt/gfp071
Rodríguez-Benítez P, Gómez-Campderá FJ. Importance of the residual renal function in hemodialysis patients. Nefrologia. 2002;22(2):98-103.
National Kidney Foundation: K/DOQI Clinical Practice Recommendations for Hemodialysis Adequacy. Guideline 6: Preservation of residual kidney function. Am J Kidney Dis 2006;48(Suppl 1):S68-70.
Kalantar-Zadeh K, Unruh M, Zager PG, Kovesdy CP, Bargman JM, Chen J, et al. Twice-weekly and incremental hemodialysis treatment for initiation of kidney replacement therapy. Am J Kidney Dis. 2014;64(2):181-6. DOI: https://doi.org/10.1053/j.ajkd.2014.04.019
Vanholder R, Van Biesen W, Lameire N. Is starting hemodialysis on a twice-weekly regimen a valid option? Am J Kidney Dis. 2014;64(2):165-7. DOI: https://doi.org/10.1053/j.ajkd.2014.06.003
Chin AI, Appasamy S, Carey RJ, Madan N. Feasibility of Incremental 2-Times Weekly Hemodialysis in Incident Patients With Residual Kidney Function. Kidney Int Rep. 2017;2(5):933-42. DOI: https://doi.org/10.1016/j.ekir.2017.06.005
Nongnuch A, Assanatham M, Panorchan K, Davenport A. Strategies for preserving residual renal function in peritoneal dialysis patients. Clin Kidney J. 2015;8(2):202-11. DOI: https://doi.org/10.1093/ckj/sfu140
Liu Y, Zou W, Wu J, Liu L, He Q. Comparison between incremental and thrice-weekly haemodialysis: Systematic review and meta-analysis. Nephrology (Carlton). 2019;24(4):438-44. DOI: https://doi.org/10.1111/nep.13252
Kuipers J, Oosterhuis JK, Krijnen WP, Dasselaar JJ, Gaillard CA, et al. Prevalence of intradialytic hypotension, clinical symptoms and nursing interventions--a three-months, prospective study of 3818 haemodialysis sessions. BMC Nephrol. 2016;17:21. DOI: https://doi.org/10.1186/s12882-016-0231-9
Zhang M, Wang M, Li H, Yu P, Yuan L, Hao C, et al. Association of Initial Twice-Weekly Hemodialysis Treatment with Preservation of Residual Kidney Function in ESRD Patients. Am J Nephrol. 2014;40(2):140-50. DOI: https://doi.org/10.1159/000365819
Fernández-Lucas M, Teruel-Briones JL, Gomis-Couto A, Villacorta-Pérez J, Quereda-Rodríguez-Navarro C. Maintaining residual renal function in patients on haemodialysis: 5-year experience using a progressively increasing dialysis regimen. Nefrologia. 2012;32(6):767-76.
Lin YF, Huang JW, Wu MS, Chu TS, Lin SL, Chen YM, et al. Comparison of residual renal function in patients undergoing twice-weekly versus three-times-weekly haemodialysis. Nephrology (Carlton). 2009;14(1):59-64. DOI: https://doi.org/10.1111/j.1440-1797.2008.01016.x