Incremental dialysis may help maintain residual renal function, improve quality of life
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KANSAS CITY, Mo. — Incremental dialysis may help patients with residual renal function, which can help reduce toxins in blood and improve patient quality of life, according to a speaker at the Annual Dialysis Conference.
“Incremental dialysis is easy,” Andrew Davenport, MD, a consultant nephrologist and honorary senior lecturer at the Royal Free Hospital in London, said in his presentation. “We can define it as taking in consideration residual renal function and therefore, what we’re talking about is starting dialysis with less frequent schedules or shorter dialysis sessions. As renal function declines, we balance that by increasing the amount of dialysis clearance.”
Patients with a small amount of residual renal function with a residual renal urea clearance of 1 mL or more per minute have less fluid removed in dialysis, which protects the body from volume overload, he said noting that dialyzing patients less frequently may help to preserve and maintain residual renal function.
In maintaining residual renal function, Davenport said there is a degree of tubular function, which means organic acid transporters can excrete toxins that are bound to proteins. These compounds are toxic to endothelial cells and can cause damage to the heart. He noted there are no current dialysis techniques that can remove protein-bound toxins and that even a small amount of residual renal function can reduce the levels of these toxins.
He also noted that recovery time for incremental dialysis is faster than thrice weekly dialysis, which may increase patient quality of life.
Not every patient will benefit from incremental dialysis, according to Davenport. Patients with a residual renal urea clearance of less than 2 mL per minute, have high weight gains or cardiovascular reserve should not be considered for incremental approaches to dialysis.
“The most important thing is prescribing dialysis to treat patients as individuals,” Davenport said. “One target does not fit everybody. People need different targets.”
Future prospective randomized trials on incremental dialysis should involve patients who represent the general dialysis population to create more relevant results, according to Davenport. – by Erin T. Welsh
Reference:
Davenport, A. Does every hemodialysis patient need to start thrice weekly treatment? Presented at: Annual Dialysis Conference; Feb 8-11, 2020, Kansas City, Missouri.