One-Size-Does-Not-Fit-All: The Case of Incremental Hemodialysis

被引:0
作者
Casino, Francesco Gaetano [1 ]
Basile, Carlo [2 ]
机构
[1] Hosp Madonna Grazie, Div Nephrol, I-75100 Matera, Italy
[2] Assoc Nefrol Gabriella Sebastio, I-74015 Martina Franca, Italy
来源
KIDNEY AND DIALYSIS | 2024年 / 4卷 / 01期
关键词
conventional hemodialysis; equivalent renal clearance; incremental hemodialysis; stdKt/V; urea kinetic model; RESIDUAL RENAL-FUNCTION; TWICE-WEEKLY HEMODIALYSIS; CLINICAL-PRACTICE GUIDELINE; DIALYSIS PATIENTS; KIDNEY-FUNCTION; EARLY MORTALITY; ASSOCIATION; PREDICTORS; INITIATION; ADEQUACY;
D O I
10.3390/kidneydial4010003
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Conventional hemodialysis (HD) (a 4 h session three times a week) is not appropriate for everyone and is excessive in the presence of substantial residual kidney function (RKF). However, it can be safely replaced by a softer incremental approach guided by the urea kinetic model (UKM), starting with one or two sessions a week. Observational data suggest that RKF may be lost less quickly if dialysis is initiated less frequently than 3 times a week. Incremental HD means that, in the presence of substantial RKF, kidney replacement therapy can begin with low doses and/or frequencies, which, however, must be adequately increased to compensate for any subsequent losses of RKF, keeping the total clearance level (kidney + dialysis) always above the minimum levels of adequacy. In HD, there are complexities in combining the dialysis dose with RKF, but tools have been developed to facilitate this issue. The literature findings lend support to the safety of incremental HD and highlight the potential for this method to be implemented as a new standard of care in dialysis patients with substantial RKF. Ongoing and future trials will likely generate further evidence of the clinical and healthcare benefits of incremental HD in routine practice.
引用
收藏
页码:27 / 36
页数:10
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