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Kidney Week

Abstract: PO0850

Improved One-Year Survival and Decreased Hospitalization Rate in Incident Hemodialysis Patients with Incremental as Compared to Standard Hemodialysis Regimen: A Single-Centre Experience

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Saudan, Patrick, Nephrology Unit, Geneva University Hospitals, Geneva, Geneva, Switzerland
  • Jaques, David Antoine, Nephrology Unit, Geneva University Hospitals, Geneva, Geneva, Switzerland
  • Alves, Cyrielle, Nephrology Unit, Geneva University Hospitals, Geneva, Geneva, Switzerland
  • Martin, Pierre-Yves F., Nephrology Unit, Geneva University Hospitals, Geneva, Geneva, Switzerland
Background

Preservation of residual kidney function (RKF) in maintenance hemodialysis (HD) patients is associated with better survival and quality of life. RKF may be better preserved with an incremental HD regimen in patients starting HD. Since 2013, incremental HD (frequency < 3x/week) has been used in our center.

Methods

Incremental HD is implemented in incident HD patients who have a daily residual diuresis > 600 ml, a urea clearance > 2 ml/mn and an interdialytic weight gain < 2.5 kgs. Patients are clinically assessed every week and a 24 hr-urine sample is collected every other month in order to measure RKF.

Results

From January 2013 to March 2020, 295 patients started chronic dialysis in our center, of whom 221 were on hemodialysis. Among them, 63 patients started maintenance HD with an incremental regimen. These patients did not differ significantly from those with a thrice-weekly HD regimen in terms of age, gender and comorbidity score. Residual diuresis, eGFR and urea clearance at incremental HD initiation were respectively 1842 + 749 ml/day, 6.7+ 3.1 ml/mn and 4.0 + 1.8 ml/mn. Among those 63 patients, four could retrieve a sufficient RKF to become dialysis-independent after a mean 6-month duration of incremental HD and 2 were transplanted while on incremental dialysis. Among the remaining 57 patients, mean duration of incremental HD until transition to a thrice-weekly HD regimen or death was 12 + 12 months (median, IQR: 10, 6-20). Within the first dialysis year, survival and hospital-free days (median, IQR) were higher in patients starting with incremental HD than in patients with a thrice-weekly HD regimen (91 vs 77%; p=0.02 and 344 (318-360) vs 338 (295-354) days; p=0.03).

Conclusion

These preliminary results show that incremental HD can be implemented in incident HD patients as long as regular clinical and RKF assessments are found adequate. However, randomised clinical trials assessing long-term survival and quality of life in incremental HD are necessary prior to its large-scale implementation.