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Davenport A. Is an incremental approach to starting haemodialysis an option for children ? J Nephrol 2023:10.1007/s40620-023-01686-w. [PMID: 37294404 DOI: 10.1007/s40620-023-01686-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Andrew Davenport
- UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, NW3 2PF, UK.
- UCL Department of Renal Medicine, Department of Medicine, Royal Free Hospital, University College London, Rowland Hill Street, London, NW3 2PF, UK.
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Davenport A, Guirguis A, Almond M, Day C, Chilcot J, Wellsted D, Farrington K. Comparison of characteristics of centers practicing incremental vs. conventional approaches to hemodialysis delivery - postdialysis recovery time and patient survival. Hemodial Int 2019; 23:288-296. [DOI: 10.1111/hdi.12743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 12/27/2022]
Affiliation(s)
| | - Ayman Guirguis
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences; University of Hertfordshire, College Lane Campus; Hatfield UK
- Renal Unit, Lister Hospital, East & North Herts NHS Trust; Coreys Mill Lane; Stevenage UK
- Oxford Health NHS Foundation Trust; Oxford UK
| | - Michael Almond
- Southend University Hospital NHS Foundation Trust; Essex UK
| | - Clara Day
- Department of Renal Medicine; Queen Elizabeth Hospital; Birmingham UK
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
| | - David Wellsted
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences; University of Hertfordshire, College Lane Campus; Hatfield UK
| | - Ken Farrington
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences; University of Hertfordshire, College Lane Campus; Hatfield UK
- Renal Unit, Lister Hospital, East & North Herts NHS Trust; Coreys Mill Lane; Stevenage UK
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Leong SC, Sao JN, Taussig A, Plummer NS, Meyer TW, Sirich TL. Residual Function Effectively Controls Plasma Concentrations of Secreted Solutes in Patients on Twice Weekly Hemodialysis. J Am Soc Nephrol 2018; 29:1992-1999. [PMID: 29728422 DOI: 10.1681/asn.2018010081] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/08/2018] [Indexed: 11/03/2022] Open
Abstract
Background Most patients on hemodialysis are treated thrice weekly even if they have residual kidney function, in part because uncertainty remains as to how residual function should be valued and incorporated into the dialysis prescription. Recent guidelines, however, have increased the weight assigned to residual function and thus reduced the treatment time required when it is present. Increasing the weight assigned to residual function may be justified by knowledge that the native kidney performs functions not replicated by dialysis, including solute removal by secretion. This study tested whether plasma concentrations of secreted solutes are as well controlled in patients with residual function on twice weekly hemodialysis as in anuric patients on thrice weekly hemodialysis.Methods We measured the plasma concentration and residual clearance, dialytic clearance, and removal rates for urea and the secreted solutes hippurate, phenylacetylglutamine, indoxyl sulfate, and p-cresol sulfate in nine patients on twice weekly hemodialysis and nine patients on thrice weekly hemodialysis.Results Compared with anuric patients on thrice weekly dialysis with the same standard Kt/Vurea, patients on twice weekly hemodialysis had lower hippurate and phenylacetylglutamine concentrations and similar indoxyl sulfate and p-cresol sulfate concentrations. Mathematical modeling revealed that residual secretory function accounted for the observed pattern of solute concentrations.Conclusions Plasma concentrations of secreted solutes can be well controlled by twice weekly hemodialysis in patients with residual kidney function. This result supports further study of residual kidney function value and the inclusion of this function in dialysis adequacy measures.
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Affiliation(s)
- Sheldon C Leong
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and.,Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
| | - Justin N Sao
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
| | - Abigail Taussig
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
| | - Natalie S Plummer
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and.,Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
| | - Timothy W Meyer
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and.,Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
| | - Tammy L Sirich
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and .,Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
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