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Abstract: TH-PO1130

Twice Weekly vs. Thrice Weekly Hemodialysis in Patients with Residual Kidney Function

Session Information

  • Late-Breaking Posters
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis


  • Lee, Seolhyun, Stanford University, Palo Alto, California, United States
  • Pham, Nhat M., Santa Clara Valley Medical Center, San Jose, California, United States
  • Bolanos, Christian G., Stanford University, Palo Alto, California, United States
  • Bonde, Saniya S., Stanford University, Palo Alto, California, United States
  • Meyer, Timothy W., Stanford University, Palo Alto, California, United States
  • Sirich, Tammy L., Stanford University, Palo Alto, California, United States

The most recent 2015 update of the Kidney Disease Outcomes Quality Initiative (KDOQI) dialysis adequacy guidelines increased the contribution assigned to residual kidney function in calculating standard Kt/Vurea (stdKt/V). However, no study has yet assessed the effect of prescribing twice weekly hemodialysis (HD) according to this guideline on patients' symptoms or uremic solute levels.


24 HD patients with residual kidney urea clearance (Kru) 4.7±1.8 ml/min completed a cross-over trial comparing 4 weeks of twice weekly (2X) HD and 4 weeks of thrice weekly (3X) HD (NCT03874117). Patients were enrolled if they had Kru >2.5 ml/min and had been on HD for at least 2 months. During the 2X period, HD was prescribed to achieve stdKt/V 2.2 incorporating Kru using the 2015 KDOQI guidelines. During the 3X period, HD was prescribed to achieve a per treatment spKt/V 1.3 regardless of Kru. Symptom scores and pre-treatment plasma levels of urea, secreted solutes p-cresol sulfate (PCS) and hippurate (HIPP), and beta-2 microglobulin (β2m) were compared at the end of each 4-week period.


Symptoms were significantly better with 2X HD, as assessed by the KDQOL36 Symptom component (2X: 86±14 vs. 3X: 82±18, p 0.001), Dialysis Symptom Index (2X: 26±26 vs. 3X: 33±31, p 0.008), and post-dialysis recovery time (2X: 1.6±0.8 vs. 3X: 1.9±1.0, p 0.01). 2X HD provided adequate stdKt/V of 2.7±0.5 without a significant increase in treatment time (2X: 195±21 min vs. 3X: 191±17 min, p 0.07). Kru, ultrafiltration rate, and pre-treatment plasma potassium were similar, and no patients were withdrawn for fluid overload or hyperkalemia. Plasma analysis showed an expected higher pre-treatment level of urea with 2X HD (76±22 vs. 54±13 mg/dl, p <0.001) while the levels of PCS (4.0±1.6 vs. 3.7±1.3 mg/dl, p 0.39), HIPP (2.7±3.0 vs. 2.2±1.9 mg/dl, p 0.84), and β2m (22±7 vs. 21±6 mg/L, p 0.80) were not significantly higher with 2X than 3X HD.


We show that 2X HD can be safely prescribed with the increased contribution assigned to Kru by the 2015 KDOQI guidelines. With 2X HD, symptoms were improved and the continuous function of the residual kidneys controlled fluid gain, potassium, and plasma levels of uremic solutes without a need to increase treatment time.


  • NIDDK Support