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Kidney Week

Abstract: PO0884

Thrice vs. Twice Weekly Hemodialysis in a Rural Community Center

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Bonagiri, Paavan, University of Virginia, Charlottesville, Virginia, United States
  • Singhania, Namrata, Mount Carmel East Hospital, Columbus, Ohio, United States
  • Singhania, Girish, University of Utah Health, Salt Lake City, Utah, United States
  • Ejaz, Abutaleb Ahsan, University of Florida, Gainesville, Florida, United States
Background

Converting stable ESRD patients from thrice to twice weekly HD sessions.

Methods

ESRD patients on 3xWkly HD sessions for at least 3 months duration were screened for eligibility for conversion to 2xWkly HD schedule in a university-affiliated community dialysis program. Eligibility criteria were: residual renal function > 3ml/min; urine output >500mL/day; intradialytic weight gain <2.5kg; hemoglobin >8gm/dL; manageable phosphorus and potasium levels. Clinical parameters on 3xwkly vs. 2xwkly HD sessions were then performed in the eligible patients. Patients were followed for 6 months post conversion.

Results

9.8% of total HD pts were eligible. Baseline characteristics: age 65.1+4.5yrs, F 57.1%, HTN 71.4%, DM 14.2%, MM 14.2%. Major indication for HD initiation was symptomatic progression of disease. Less than 50% of patients had a functioning arteriovenous fistula at initiation of HD. In the current cohort, residual renal function > 3mL/min was maintained for > 200 days after initiation of HD. There were no significant changes in electrolytes, hemoglobin, nutrition staus or adequacy of dialysis. PTH levels were not significantly different: 3xwkly, 625.7+546.2pg/mL vs. 2xwkly, 399+344.2pg/mL; p=0.374). Karnofsky Performance Status Scale improved post conversion but did not achieve statistical significance (3xwkly, 57.1 vs. 2xwkly, 70; p=0.316). There were no hospital admissions since conversion to 2xwkly schedule during the study period.

Conclusion

10% of total HD patients qualified for conversion from 3xWkly to 2xWkly maintenance HD without significant changes to laboratory or clinical performance measures. These observations stimulate discussion regarding increased application of incremental dialysis initiation strategies to preserve residual renal function, increase dialysis-free days and alleviate transportation and care provider-related burden to patients and families, especially in underserved areas.

Comparison of Clinical and laboratory parameters.