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Torreggiani M, Fois A, Chatrenet A, Nielsen L, Gendrot L, Longhitano E, Lecointre L, Garcia C, Breuer C, Mazé B, Hami A, Seret G, Saulniers P, Ronco P, Lavainne F, Piccoli GB. Incremental and Personalized Hemodialysis Start: A New Standard of Care. Kidney Int Rep 2022; 7:1049-1061. [PMID: 35571001 PMCID: PMC9091804 DOI: 10.1016/j.ekir.2022.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/07/2022] [Indexed: 12/21/2022] Open
Abstract
Introduction Incremental hemodialysis (iHD) may attenuate “dialysis shock” and reduce costs, preserving quality of life. It is considered difficult to reconcile with HD wards’ routine; fear of underdialysis and increasing mortality are additional concerns. The aim of this study was to evaluate mortality, morbidity, and costs in a large HD ward where iHD is the standard of HD start. Methods This observational study included all incident HD patients in 2017 to 2021, stratified according to HD start: iHD (1–2 sessions/wk), decremental HD (dHD, 3 sessions/wk at start, later reduced), or standard (3 sessions/wk). Results were compared with data recorded in the same unit before the incremental program (2015–2017) and with a propensity score-matched cohort from the French Renal Epidemiology and Information Network (REIN) registry. Results A total of 158 patients started HD in 2017 to 2021, 57.6% on iHD, 8.9% dHD, and 33.5% standard HD schedule. Patients on the standard schedule had lower initial estimated glomerular filtration rate (eGFR) (5 vs. 7 ml/min per 1.72 m2, P = 0.003). We found no survival differences according to period of start (same center) and propensity score matching (REIN). Patients intensively followed in the pre-HD period were more likely to start on iHD-dHD. Persistence on iHD-dHD was about 50% at 1 year and 35% at 2 years. Hospitalization rates and time to first hospitalization or death did not differ between the schedules. The iHD-dHD policy allowed a 16% cost saving, even accounting for supplemental biochemical tests. Conclusion Our study reveals that iHD can be a new standard of care, as it is safe and feasible in up to two-thirds of patients on incident HD.
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Jakulj L, Kramer A, Åsberg A, de Meester J, Santiuste de Pablos C, Helve J, Hemmelder MH, Hertig A, Arici M, Bell S, Mercadal L, Diaz-Corte C, Palsson R, Benitez Sanchez M, Kerschbaum J, Collart F, Massy ZA, Jager KJ, Noordzij M. Recovery of kidney function in patients treated with maintenance dialysis-a report from the ERA-EDTA Registry. Nephrol Dial Transplant 2020; 36:1078-1087. [PMID: 33355661 DOI: 10.1093/ndt/gfaa368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Literature on recovery of kidney function (RKF) in patients with end-stage kidney disease treated with maintenance dialysis (i.e. >90 days) is limited. We assessed the incidence of RKF and its associated characteristics in a European cohort of dialysis patients. METHODS We included adult patients from the European Renal Association-European Dialysis and Transplant Association Registry who started maintenance dialysis in 1997-2016. Sustained RKF was defined as permanent discontinuation of dialysis. Temporary discontinuation of ≥30 days (non-sustained RKF) was also evaluated. Factors associated with RKF adjusted for potential confounders were studied using Cox regression analyses. RESULTS RKF occurred in 7657 (1.8%) of 440 996 patients, of whom 71% experienced sustained RKF. Approximately 90% of all recoveries occurred within the first 2 years after Day 91 of dialysis. Of patients with non-sustained RKF, 39% restarted kidney replacement therapy within 1 year. Sustained RKF was strongly associated with the following underlying kidney diseases (as registered by the treating physician): tubular necrosis (irreversible) or cortical necrosis {adjusted hazard ratio [aHR] 20.4 [95% confidence interval (CI) 17.9-23.1]}, systemic sclerosis [aHR 18.5 (95% CI 13.8-24.7)] and haemolytic uremic syndrome [aHR 17.3 (95% CI 13.9-21.6)]. Weaker associations were found for haemodialysis as a first dialysis modality [aHR 1.5 (95% CI 1.4-1.6)] and dialysis initiation at an older age [aHR 1.8 (95% CI 1.6-2.0)] or in a more recent time period [aHR 2.4 (95% CI 2.1-2.7)]. CONCLUSIONS Definitive discontinuation of maintenance dialysis is a rare and not necessarily an early event. Certain clinical characteristics, but mostly the type of underlying kidney disease, are associated with a higher likelihood of RKF.
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Affiliation(s)
- Lily Jakulj
- Department of Internal Medicine and Nephrology, Dianet Dialysis Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anneke Kramer
- Department of Medical Informatics, European Renal Association-European Dialysis and Transplant Association Registry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Johan de Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | - Carmen Santiuste de Pablos
- Department of Epidemiology, Murcia Renal Registry, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.,CIBER Epidemiologíca y Salud Públican, Madrid, Spain
| | - Jaakko Helve
- Finnish Registry for Kidney Diseases and Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Marc H Hemmelder
- Dutch Renal Registry Renine, Nefrovisie Foundation, Utrecht, The Netherlands
| | - Alexandre Hertig
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Kidney Transplantation, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Samira Bell
- Scottish Renal Registry, Meridian Court, ISD Scotland, Glasgow, UK
| | - Lucile Mercadal
- Institut National de la Santé et de la Recherche Médicale, Center for Renal and Cardiovascular Epidemiology, Villejuif, France.,Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital de La Pitié Salpêtrière Hospital, Paris, France
| | - Carmen Diaz-Corte
- Nephrology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.,Red de Investigación Renal, Madrid, Spain
| | - Runolfur Palsson
- Division of Nephrology, Landspítali-The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Julia Kerschbaum
- Department for Internal Medicine IV-Nephrology and Hypertension, Austrian Dialysis and Transplant Registry, Medical University Innsbruck, Innsbruck, Austria
| | | | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, Paris, France.,Institut National de la Santé et de la Recherche Médicale Unit 1018 Team 5, Research Centre in Epidemiology and Population Health, University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, France
| | - Kitty J Jager
- Department of Medical Informatics, European Renal Association-European Dialysis and Transplant Association Registry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marlies Noordzij
- Department of Medical Informatics, European Renal Association-European Dialysis and Transplant Association Registry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Tsai JL, Tsai SF. Recovery of Renal Function in a Kidney Transplant Patient After Receiving Hemodialysis for 4 Months. EXP CLIN TRANSPLANT 2018; 18:112-115. [PMID: 30066627 DOI: 10.6002/ect.2017.0323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Renal transplant is the preferred choice of treatment for end-stage renal diseases. To avoid rejection, increasingly potent immunosuppressants are administered to recipients of kidney transplants. Complications, when there is excess immunosuppression, include possible lethal infections, which reduce allograft survival and compromise patient survival. When there is insufficient immunosuppression, rejections could impair allograft outcomes. Moreover, recurrent primary diseases could also threaten allograft outcomes. Here, we report a case of a patient who underwent ABO-incompatible and living-related renal transplant in which the patient experienced 7 acute kidney injury episodes, including recurrent malignant hypertension, rejection, and infections. After the patient underwent 4 months of hemodialysis (with serum creatinine level of 17 mg/dL), which was later terminated, no adverse effects were found for 1 year (serum creatinine level of 3.7 mg/dL). Therefore, renal function recovery may be longer in patients with renovascular diseases with hypertension. For recipients undergoing hemodialysis with allograft failure, we suggest that the treatment should be not completely withdrawn of immunosuppressants so that acute kidney injuries are minimized. Even after prolonged hemodialysis (eg, for 4 months), recipients may still be able to recover renal function.
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Affiliation(s)
- Jun-Li Tsai
- From the Department of Family Medicine, Cheng Ching General Hospital, Taichung, Taiwan
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Qazi HA, Chen H, Zhu M. Factors influencing dialysis withdrawal: a scoping review. BMC Nephrol 2018; 19:96. [PMID: 29699499 PMCID: PMC5921369 DOI: 10.1186/s12882-018-0894-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/11/2018] [Indexed: 11/15/2022] Open
Abstract
Background Research on factors associated with dialysis withdrawal is scarce. This study examined the predictors that might influence rate of dialysis withdrawal. Existing literature is summarized, analyzed and synthesized to identify gaps in the literature with regard to the factors associated with dialysis withdrawal. Methods This scoping review used a systematic search to synthesize research findings related to dialysis withdrawal and identified gaps in the literature. The search strategy was developed and applied using PubMed, EMBASE and CINHAL databases. The selection criteria included articles written in English and published between 1997 and 2016 that examined dialysis withdrawal and associated factors in patients with any modality of renal dialysis.. Case reports and studies only including renal transplant patients were excluded. Fifteen articles were selected in accordance with these selection criteria. Results The literature review revealed a scarcity of research on dialysis withdrawal and associated factors. Furthermore, the study findings were inconsistent and inconclusive. Authors have defined dialysis withdrawal in terms of dialysis discontinuation, withholding, death, withdrawal, treatment refusal/cessation, or technique failure. Authors have selected homogeneous patient population on either hemodialysis (HD) or peritoneal dialysis (PD) patients, thus making comparisons of studies and generalization of findings difficult. Conclusion Future studies should explore the influence of both HD and PD on patient-elected dialysis withdrawal using a large a priori calculated sample size. Electronic supplementary material The online version of this article (10.1186/s12882-018-0894-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hammad Ali Qazi
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada.
| | - Helen Chen
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Meng Zhu
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Nava J, Moran S, Figueroa V, Salinas A, Lopez M, Urbina R, Gutierrez A, Lujan JL, Orozco A, Montufar R, Piccoli GB. Successful pregnancy in a CKD patient on a low-protein, supplemented diet: an opportunity to reflect on CKD and pregnancy in Mexico, an emerging country. J Nephrol 2017; 30:877-882. [PMID: 28918595 DOI: 10.1007/s40620-017-0428-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/03/2017] [Indexed: 12/13/2022]
Abstract
Pregnancy is probably the most important challenge in young women with chronic kidney disease (CKD). The challenge is greater in developing countries, in which access to dialysis is uneven, and prenatal care for CKD patients is not uniformly available. This case report summarizes some of the challenges faced by pregnant CKD women in a developing country. A 35-year-old woman, affected by an undiagnosed kidney disease, experienced preeclampsia at 24 years of age, and started dialysis in emergency at age 31 in the context of severe preeclampsia in her second pregnancy. Following slow recovery of kidney function, after 18 months of dialysis she started a moderately restricted, supplemented, low-protein diet, which allowed her to discontinue dialysis. A few months after dialysis discontinuation, she started a new pregnancy in the presence of severely reduced kidney function (serum creatinine 4.6 mg/dl at the last pre-pregnancy control). Interestingly, she discontinued nephrology and nutritional follow-up, mainly because she was worried that she would be discouraged from continuing the pregnancy, but also because she continued to feel well. She self-managed her diet in pregnancy and delivered a healthy baby, with normal intrauterine growth, at term; while the last laboratory data confirmed the presence of severe kidney function impairment, she is still dialysis-free at the time of the present report. Her story, with its happy ending, underlines the importance of dedicated programs for CKD pregnancies in developing countries and confirms the safety of moderately protein-restricted diets in pregnancy.
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Affiliation(s)
- Julia Nava
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Silvia Moran
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Veronica Figueroa
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Adriana Salinas
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Margy Lopez
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Rocio Urbina
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Abril Gutierrez
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Jose Luis Lujan
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Alejandra Orozco
- Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPER), Calle Montes Urales 800, Ciudad de Mexico, Mexico
| | - Rafael Montufar
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico.
| | - Giorgina B Piccoli
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Turin, Italy.
- Nephrologie, Centre Hospitalier Le Mans, Avenue Roubillard, 72000, Le Mans, France.
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