Abstract: SA-PO985
Is Initiation of Twice-Weekly Maintenance Hemodialysis an Acceptable Option?
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
- Mendonca, Satish, Army Hospital (Research & Referral), New Delhi, India
- Gupta, Devika, Army Hospital (Research & Referral), New Delhi, India
Background
Twice weekly maintenance hemodialysis (HD) is not an acceptable form of renal replacement therapy primarily because there are not enough studies to prove its sustainability. However with the concept of incremental dialysis and residual renal function gaining ground this can definitely prove to be a good option for initiation of hemodialysis. The benefits of twice weekly hemodialysis at initiation are significant with respect to economic issues, patient quality of life, access longevity and preservation of residual renal function. We present a three year follow up of patients on twice weekly HD and outcomes.
Methods
This was a three year observational folllow up of 88 patients initiated on twice weekly HD. Children, pregnant ladies, and patients being worked up for renal transplant were excluded from the study. Adequacy and basic cost effective hematologial and biochemical parameters were studied monthly in each patient. In case of complications develoing in the form of recurrent fluid overload, uncontrolled hypertension, refractory anaemia, hyperphosphatemia and features of malnutrition, the patient was shifted to thrice weekly HD.
Results
16406 sessions of HD were studied analysing adequacy, residual renal function, cardiovascular outcomes, mineral bone status and socioeconomic factors and vascular access. Majority of the patients had a urine output of 1176 ml at initaion with a RRF of 3.1ml/min. BP was controlled in 93.19% of patients and left ventricular hypertrophy was seen in 37.2%. SpKt/v was 1.75, eKt/V was 1.38 and Std Kt/V was 2.8. IDWG was 1.91 Kgs with a mean ultrafiltration of 2600ml. There were 27.2% deaths during this period the commonest cause being cardiovascular causes and emergency HD was required in 0.24% of sessions.
Conclusion
Twice weekly HD at initiation is a favourable option with increments, in case of requirement, as majority of patients had a good urine output and RRF at commencement. It also preserves the residual renal function, reduces cost and improves the quality of life. Lack of vascular access is a major cause of morbidity and mortality as seen and more focus is required at this end. Adequacy parameters are fallaciously high as they are dependent on ultrafiltration volumes and body weight. A prime factor favouring twice wekly HD is economic and social factors in the form of cost of travel and distance/time to reach dialysis centre.
Funding
- Government Support - Non-U.S.