Is Twice-weekly Maintenance Hemodialysis Justified?

Abstract

Background: The benefits of twice-weekly dialysis at initiation are significant with respect to access longevity, preservation of residual renal function, economic factors, and patient quality of life. It is widely practiced in developing countries due to resource and financial constraints. We present a 3-year follow-up of patients on twice-weekly dialysis and their outcomes.

Material and methods: This was a 3-year observational follow-up study of patients initiated on twice-weekly hemodialysis. Adequacy and basic cost-effective hematological and biochemical parameters were studied monthly. In case of complications, the patient was shifted to thrice-weekly hemodialysis.

Results: 88 incident hemodialysis patients were followed up. Total sessions of hemodialysis (HD) studied were 16,406. The mean hemoglobin level was 9.53 g/dl with hyperphosphatemia in 74.88% patients. The mean residual renal function (RRF) at initiation was 5.71 +/- 3.70 ml/min. The mean interdialytic weight gain was 1.91 +/- 1.26 kg with a mean ultrafiltration of 2600 ± 410 ml. The spKt/V and eKt/V were adequate in 68.54% and 48.34% patients; however, the standard Kt/V of 2 was achieved in only 10.51% patients. Emergency HD was done in 41 sessions (0.24%). There were 24 deaths (27.27%) during this period with the mean time to mortality being 503.12 +/- 296.62 days.

Conclusion: Initiation at twice-weekly schedules for patients on maintenance hemodialysis is a viable option with increments in case of requirement, more so in patients with good urine output and residual renal function. The biochemical and hematological parameters were stable and within KDOQI guidelines and do not worsen with time.

Keywords: Adequacy of dialysis; residual renal function; survival; twice-weekly hemodialysis.

Figure 1

Access at initiation of hemodialysis. Footnote: DLJC: Double lumen Jugular Catheter, AVF: Arterio venous Fistula

Figure 2

Regression analysis showing the percentage decrease of urine output over time

Figure 3

Kaplan-Meier survival curve for 88 patients for all cause mortality

Figure 4

Hazard function for all cause mortality for 88 patients on twice weekly hemodialysis

Figure 5

Temporal profile of hematological and biochemical parameters over time. (X axis denotes time of follow up whereas Y axis shows that numerical value of laboratory parameters is sustained over time)