Incremental hemodialysis initiation on residual kidney function is feasible, safe
Incremental hemodialysis showed fewer adverse events in patients with residual kidney function compared with standard hemodialysis treatment, according to results of a pilot study.
“The main study aim was to establish the feasibility of conducting a definitive randomized controlled study of incremental [vs.] standard HD in patients with adequate RKF initiating dialysis,” Enric Vilar, MB, MA, MRCP, PhD, consultant nephrologist at Lister Hospital and senior clinical lecturer at the University of Hertfordshire, and colleagues wrote.
In a randomized controlled feasibility trial, researchers analyzed 55 patients on incident hemodialysis (HD) with urea clearance of 3 mL/min/1.73 m² or more to determine the impact of incremental vs. conventional initiation of HD on residual kidney function (RKF).
Researchers randomly assigned the participants into two arms. Twenty-six patients received standard HD protocol three times a week for 3.5 to 4 hours and had a minimum dialysis standard td (SKt/V) of 2. The mean age of these patients was 63.1 ± 12.3 years, and 73.1% of the group were male patients. According to the study, 84% were categorized as “Caucasian,” 7.7% were “Black African/Afro-Caribbean,” and 7.7% were “Asian.”
Twenty-nine participants received incremental HD protocol twice a week, upwardly adjusting doses as RKF was lost maintaining total (dialysis and renal) Std Kt/V above 2. The mean age of this group was 61.4 ± 15.2 years, and 61.4% of the group were male patients. According to the study, 75.9% were “Caucasian,”6.9% were “Black African/Afro-Caribbean,” and 17.2% were “Asian.”
Primary outcomes of the study were feasibility parameters and effect size of group differences in rates of loss of RKF at 6 months, which was halfway through the 12-month study.
At 6 months, 92% of patients in the incremental cohort and 75% of patients in the standard arm had a urea clearance of 2 mL/min/1.73 m² or more. While serious adverse events were less common in patients in the incremental cohort (incidence rate ratio 0.47, confidence interval 0.27-0.81), they experienced significantly lower serum bicarbonate. Researchers reported three deaths in each arm.
“Overall, we found incremental initiation to be safe, associated with fewer adverse events, hospitalizations, and lower cost than standard treatment. There was no discernible impact on rate of loss of RKF, nor on quality of life, mood, cognitive function and illness intrusiveness. However, this was a small pilot study with insufficient power to draw firm statistical conclusions,” Vilar and researchers wrote. “Future trials should also assess the health economics benefits of lower intensity dialysis regimes.”