Twice-weekly and incremental hemodialysis treatment for initiation of kidney replacement therapy

Kamyar Kalantar-Zadeh, Mark Unruh, Philip G. Zager, Csaba Kovesdy, Joanne M. Bargman, Jing Chen, Suresh Sankarasubbaiyan, Gaurang Shah, Thomas Golper, Richard A. Sherman, David S. Goldfarb

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Mortality is highest in the first months of maintenance hemodialysis (HD) therapy. In many Western countries, patients who transition to kidney replacement therapy usually begin thrice-weekly HD regardless of their level of residual kidney function (RKF). RKF is a major predictor of survival. RKF may decline more rapidly with thrice-weekly HD treatments, is associated with a reduced need for dialytic solute clearance, and is an important factor in the prescription of peritoneal dialysis. In this article, we review the concept of incremental HD, in which weekly dialysis dose, in particular HD treatment frequency, is based on a variety of clinical factors, such as RKF (including urine output > 0.5 L/d), volume status, cardiovascular symptoms, body size, potassium and phosphorus levels, nutritional status, hemoglobin level, comorbid conditions, hospitalizations, and health-related quality of life. These 10 clinical criteria may identify which patients might benefit from beginning maintenance HD therapy twice weekly. Periodic monitoring of these criteria will determine the timing for increasing dialysis dose and frequency. We recognize that twice-weekly HD represents a major paradigm shift for many clinicians and jurisdictions. Therefore, we propose conducting randomized controlled trials of twice-weekly versus thrice-weekly HD to assess the potential of twice-weekly HD to improve survival and health-related quality of life while simultaneously reducing costs, protecting fragile vascular accesses, and optimizing resource use during the first year of hemodialysis therapy. Such incremental and individualized HD therapy may prove to be the most appropriate approach for transitioning to dialytic therapy.

Original languageEnglish (US)
Pages (from-to)181-186
Number of pages6
JournalAmerican Journal of Kidney Diseases
Volume64
Issue number2
DOIs
StatePublished - Jan 1 2014

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Renal Replacement Therapy
Renal Dialysis
Therapeutics
Kidney
Dialysis
Maintenance
Quality of Life
Patient Transfer
Survival
Body Size
Peritoneal Dialysis
Nutritional Status
Phosphorus
Prescriptions
Blood Vessels
Potassium
Hemoglobins
Hospitalization
Randomized Controlled Trials
Urine

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Twice-weekly and incremental hemodialysis treatment for initiation of kidney replacement therapy. / Kalantar-Zadeh, Kamyar; Unruh, Mark; Zager, Philip G.; Kovesdy, Csaba; Bargman, Joanne M.; Chen, Jing; Sankarasubbaiyan, Suresh; Shah, Gaurang; Golper, Thomas; Sherman, Richard A.; Goldfarb, David S.

In: American Journal of Kidney Diseases, Vol. 64, No. 2, 01.01.2014, p. 181-186.

Research output: Contribution to journalArticle

Kalantar-Zadeh, K, Unruh, M, Zager, PG, Kovesdy, C, Bargman, JM, Chen, J, Sankarasubbaiyan, S, Shah, G, Golper, T, Sherman, RA & Goldfarb, DS 2014, 'Twice-weekly and incremental hemodialysis treatment for initiation of kidney replacement therapy', American Journal of Kidney Diseases, vol. 64, no. 2, pp. 181-186. https://doi.org/10.1053/j.ajkd.2014.04.019
Kalantar-Zadeh, Kamyar ; Unruh, Mark ; Zager, Philip G. ; Kovesdy, Csaba ; Bargman, Joanne M. ; Chen, Jing ; Sankarasubbaiyan, Suresh ; Shah, Gaurang ; Golper, Thomas ; Sherman, Richard A. ; Goldfarb, David S. / Twice-weekly and incremental hemodialysis treatment for initiation of kidney replacement therapy. In: American Journal of Kidney Diseases. 2014 ; Vol. 64, No. 2. pp. 181-186.
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