Incremental short daily home hemodialysis: a case series

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 descr...

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Autores principales: Toth-Manikowski, Stephanie M., Mullangi, Surekha, Hwang, Seungyoung, Shafi, Tariq
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5498869/
https://www.ncbi.nlm.nih.gov/pubmed/28679363
http://dx.doi.org/10.1186/s12882-017-0651-1
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author Toth-Manikowski, Stephanie M.
Mullangi, Surekha
Hwang, Seungyoung
Shafi, Tariq
author_facet Toth-Manikowski, Stephanie M.
Mullangi, Surekha
Hwang, Seungyoung
Shafi, Tariq
author_sort Toth-Manikowski, Stephanie M.
collection PubMed
description 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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spelling pubmed-54988692017-07-10 Incremental short daily home hemodialysis: a case series Toth-Manikowski, Stephanie M. Mullangi, Surekha Hwang, Seungyoung Shafi, Tariq BMC Nephrol Case Report 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. BioMed Central 2017-07-05 /pmc/articles/PMC5498869/ /pubmed/28679363 http://dx.doi.org/10.1186/s12882-017-0651-1 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Toth-Manikowski, Stephanie M.
Mullangi, Surekha
Hwang, Seungyoung
Shafi, Tariq
Incremental short daily home hemodialysis: a case series
title Incremental short daily home hemodialysis: a case series
title_full Incremental short daily home hemodialysis: a case series
title_fullStr Incremental short daily home hemodialysis: a case series
title_full_unstemmed Incremental short daily home hemodialysis: a case series
title_short Incremental short daily home hemodialysis: a case series
title_sort incremental short daily home hemodialysis: a case series
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5498869/
https://www.ncbi.nlm.nih.gov/pubmed/28679363
http://dx.doi.org/10.1186/s12882-017-0651-1
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