Abstract: SA-PO986
Planned Incremental Hemodialysis (PIHD) Is a Cost-Effective and Patient-Centered Renal Replacement Therapy (RRT)
Session Information
- Hemodialysis and Frequent Dialysis - V
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Takahashi, Toshimasa, Bousei Shinjyuku Minamiguti Clinic, Tokyo, Japan
- Nakao, Toshiyuki, Organization for Kidney and Metabolic Disease Treatment, Setagaya ward, Japan
- Kanazawa, Yoshie, Organization for Kidney and Metabolic Disease Treatment, Setagaya ward, Japan
Background
Hemodialysis (HD) in Japan is the highest quality of RRT in the world, but its cost is increasing continuously. The conventional thrice-weekly regimen is a common way to introduce HD but not Incremental hemodialysis (IHD) in Japan. When HD patients’ conditions are sufficiently managed by once-/twice-weekly HD with good adherence to their diet, its cost reduction effect can be expected.
Methods
We selected 26 CKDG5 outpatients with good-adhered of diet, we initiated PIHD considered residual renal function individually and careful follow-ups from 2013 to 2018. The average age was 63.7 (36 to 90), and 69.2% was men. Their causes of ESRD include chronic glomerulonephritis (38.5%), diabetic kidney disease (26.9%), nephrosclerosis (23.1%), and others (11.5%; polycystic kidney disease, chronic interstitial nephritis, Hypoplastic kidney). We also examined the cost of IHD.
Results
Initiation of HD was performed as follows:
11 patients were treated with once-weekly HD, and their mean eGFR was 4.49 and mean urine volume was 1510 mL/day. 15 patients were treated with twice-weekly HD, and their mean eGFR was 2.97 and mean urine volume was 1278 mL/day. At the end of 2018, six patients, who had been treated once-weekly for 8 months on average, were transited to twice-weekly HD. Five patients, who had been treated twice-weekly for 15.6 months on average, were transited to thrice-weekly HD. Three patients have continued once-weekly HD for 3 to 11 months. 13 patients have continued twice-weekly HD for 16.4 months on average. The overall 1-year survival rate of PIHD was 91.8%, and the 5-year survival rate was 88.3%. On January 2019, we have 27 (24.5%) once-/twice weekly and 87 thrice-weekly HD patients(total 110 maintenance HD) in our clinic. The monthly costs of dialysis in January 2019 were as follows: 146,000 yen for once-weekly, 254,500 yen for twice-weekly, and 396,200 yen for thrice-weekly HD. The calculated one-year cost of 110 patients was reduced by 10.02% as compared with the cost for all patients receiving the conventional thrice-weekly HD (4.28 vs 4.76 million yen/year, respectively.)
Limitation: The cost of January 2019 is based on the current Japanese medical insurance system. Selection bias cannot be avoided.
Conclusion
PIHD is a patient-centered RRT that provides cost-effective and sustainable treatment for ESRD patients.