Table of Contents
Advances in Nephrology
Volume 2014 (2014), Article ID 236245, 6 pages
http://dx.doi.org/10.1155/2014/236245
Clinical Study

Incremental Hemodialysis Schedule in Patients with Higher Residual Renal Function at the Start of Dialysis

Department of Nephrology, Hospital Ramón y Cajal, 28034 Madrid, Spain

Received 20 June 2014; Revised 14 September 2014; Accepted 2 October 2014; Published 28 October 2014

Academic Editor: Deepak Malhotra

Copyright © 2014 Milagros Fernández Lucas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We present an observational study to evaluate a progressive schedule of dose of dialysis, starting with 2 HD/week, when the renal clearance of urea was equal to or greater than 2,5 mL/min/1,73 m2 and the patient is in a stable clinical situation. From 2006 to 2011, 182 patients started hemodialysis in our center, of which 134 were included in the study. Residual renal function (RRF), Kt/V, eKru, nPCR, hemoglobin, weekly erythropoietin dose, and beta-2-microglobulin were determined at 6, 12, 18, 24, and 30 months after dialysis initiation. Seventy patients (52%) began with the progressive schedule of 2 HD/week and 64 (48%) patients began with the conventional thrice-weekly schedule (3 HD/week). The decline of RRF was lower in the group of 2 HD/week: 0,20 (0,02–0,53) versus 0,50 (0,14–1,08) mL/min/month (median and interquartile range, ). No relationship was found between the decline rate and the basal RRF. Survival analysis did not show differences between both groups. Our experience demonstrates that patients with higher residual renal function may require less than conventional 3 HD sessions per week at the start of dialysis. Twice-weekly hemodialysis schedule is safe and cost-effective and may have additional benefit in maintaining the residual renal function.