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REVIEW  CONSERVATIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE: HOW TO AVOID OR DEFER DIALYSIS 

Panminerva Medica 2017 June;59(2):188-96

DOI: 10.23736/S0031-0808.17.03299-2

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Incremental and infrequent hemodialysis: a new paradigm for both dialysis initiation and conservative management

Connie M. RHEE, Mehrdad GHAHREMANI-GHAJAR, Yoshitsugu OBI, Kamyar KALANTAR-ZADEH

Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA


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Registry or national dialysis data show that a sizeable proportion of contemporary dialysis patients have substantial levels of residual kidney function especially upon transitioning to dialysis therapy. However, among incident hemodialysis patients, the prevailing paradigm has been to initiate “full-dose” triweekly treatment schedules irrespective of native kidney function in most developed countries. Recognizing the benefits of residual kidney function upon the health and survival of dialysis patients, there has been growing interest in incremental hemodialysis, in which dialysis frequency and dose are tailored according to the degree of patients’ residual kidney function. Infrequent hemodialysis can also be used for those who prefer a more conservative approach in managing uremia. Clinical practice guidelines support the use of twice-weekly hemodialysis among patients with adequate residual kidney function (renal urea clearance >3 mL/min/1.73 m2), and a growing body of evidence indicates that incremental hemodialysis is associated with better preservation of residual kidney function without adversely impacting survival. Nonetheless, incremental hemodialysis remains an underutilized approach in this population. In this review, we will discuss the history of the twice- versus triweekly hemodialysis schedules; current clinical practice guidelines regarding infrequent hemodialysis; emerging data on incremental treatment regimens and outcomes; and guidelines for the practical implementation of incremental and infrequent hemodialysis in the clinical setting.


KEY WORDS: Renal dialysis - Kidney function tests - Conservative treatment

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