Key result
Thrice-weekly hemodialysis is linked to ~1.7 kg/week greater interdialytic weight gain and better pre-dialysis SBP.
Why the study?
There are scarce data about which patients' clinic status changes by increasing hemodialysis treatment frequency from twice to thrice weekly.
Does transitioning from twice- to thrice-weekly hemodialysis improve hemodynamic and laboratory indices in patients with incident end-stage renal disease?
Cohort (n=569)
Does transitioning from twice- to thrice-weekly hemodialysis improve hemodynamic and laboratory indices in patients with incident end-stage renal disease?
Mean Difference: 1.7 (95% CI 1.5–1.9)
Transitioning from twice- to thrice-weekly hemodialysis is associated with increased weekly interdialytic weight gain and better pre-dialysis systolic blood pressure control.
May warrant caution for greater interdialytic weight gain; leaves open net benefit of thrice-weekly hemodialysis in incident ESRD.
OBJECTIVE: Incremental hemodialysis (HD) is a strategy utilized to gradually intensify dialysis among patients with incident end-stage renal disease. However, there are scarce data about which patients' clinic status changes by increasing treatment frequency. METHODS: We retrospectively examined statistically de-identified data from 569 patients who successfully transitioned from twice- to thrice-weekly HD (2007-2011) and compared the differences in monthly-averaged values of hemodynamic and laboratory indices during the 3 months before and after the transition with the values at 1 month prior to transition serving as the reference. RESULTS: At 3 months after transitioning from twice- to thrice-weekly HD, ultrafiltration volume decreased by 0.5 (95% CI 0.3-0.6) L/session among 189 patients (33%) with weekly interdialytic weight gain (IDWG) ≥5.4 kg/week, and increased by 0.4 (95% CI 0.3-0.5) L/session among 186 patients (33%) with weekly IDWG <3.3 kg/week. Weekly IDWG consistently increased after the transition irrespective of baseline values (1.7 [95% CI 1.5-1.9] kg/week). Pre-HD systolic blood pressure (SBP) decreased by 12 (95% CI 9-14) mm Hg among 177 patients (31%) with baseline pre-HD SBP ≥160 mm Hg, which coincided with a decreasing trend in post-HD body weight (1.3 [95% CI 0.8-1.7] kg). DISCUSSION: In conclusion, patients who increased HD frequency from twice to thrice weekly treatment experienced increased weekly IDWG and better pre-HD SBP control with lower post-HD body weight.
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Hur et al. (2020) conducted a cohort in Incident end-stage renal disease (n=569). Transition from twice- to thrice-weekly hemodialysis vs. 1 month prior to transition (twice-weekly hemodialysis) was evaluated on Change in weekly interdialytic weight gain (IDWG) (MD 1.7 kg/week, 95% CI 1.5-1.9). Transitioning from twice- to thrice-weekly hemodialysis was associated with increased weekly interdialytic weight gain (1.7 kg/week; 95% CI 1.5-1.9) and better pre-dialysis systolic blood pressure.
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