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- Title
Incremental Hemodialysis: The University of California Irvine Experience.
- Authors
Ghahremani‐Ghajar, Mehrdad; Rojas‐Bautista, Vanessa; Lau, Wei‐Ling; Pahl, Madeleine; Hernandez, Miguel; Jin, Anna; Reddy, Uttam; Chou, Jason; Obi, Yoshitsugu; Kalantar‐Zadeh, Kamyar; Rhee, Connie M.
- Abstract
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.
- Subjects
CALIFORNIA; HEMODIALYSIS; TREATMENT of chronic kidney failure; KIDNEY function tests; KIDNEY transplantation; QUALITY of life; ACADEMIC medical centers; CHRONIC kidney failure; GLOMERULAR filtration rate; KIDNEYS; LONGITUDINAL method; RESEARCH funding; SURVIVAL; TIME; TREATMENT effectiveness; RETROSPECTIVE studies
- Publication
Seminars in Dialysis, 2017, Vol 30, Issue 3, p262
- ISSN
0894-0959
- Publication type
journal article
- DOI
10.1111/sdi.12591