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2017 ; 18
(1
): 216
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Incremental short daily home hemodialysis: a case series
#MMPMID28679363
Toth-Manikowski SM
; Mullangi S
; Hwang S
; Shafi T
BMC Nephrol
2017[Jul]; 18
(1
): 216
PMID28679363
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BACKGROUND: Patients starting dialysis often have substantial residual kidney
function. Incremental hemodialysis provides a hemodialysis prescription that
supplements patients' residual kidney function while maintaining total (residual
+ dialysis) urea clearance (standard Kt/Vurea) targets. We describe our
experience with incremental hemodialysis in patients using NxStage System One for
home hemodialysis. CASE PRESENTATION: From 2011 to 2015, we initiated 5 incident
hemodialysis patients on an incremental home hemodialysis regimen. The
biochemical parameters of all patients remained stable on the incremental
hemodialysis regimen and they consistently achieved standard Kt/Vurea targets. Of
the two patients with follow-up >6 months, residual kidney function was preserved
for ?2 years. Importantly, the patients were able to transition to home
hemodialysis without automatically requiring 5 sessions per week at the outset
and gradually increased the number of treatments and/or dialysate volume as the
residual kidney function declined. CONCLUSIONS: An incremental home hemodialysis
regimen can be safely prescribed and may improve acceptability of home
hemodialysis. Reducing hemodialysis frequency by even one treatment per week can
reduce the number of fistula or graft cannulations or catheter connections by
>100 per year, an important consideration for patient well-being, access
longevity, and access-related infections. The incremental hemodialysis approach,
supported by national guidelines, can be considered for all home hemodialysis
patients with residual kidney function.
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