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. 2022 Feb 19;7(5):1049-1061.
doi: 10.1016/j.ekir.2022.02.010. eCollection 2022 May.

Incremental and Personalized Hemodialysis Start: A New Standard of Care

Massimo Torreggiani  1 , Antioco Fois  1 , Antoine Chatrenet  1   2 , Louise Nielsen  1   3 , Lurlynis Gendrot  1   4 , Elisa Longhitano  1   5 , Léna Lecointre  6 , Claudine Garcia  1 , Conrad Breuer  6 , Béatrice Mazé  1 , Assia Hami  7 , Guillaume Seret  8 , Patrick Saulniers  9 , Pierre Ronco  1   10 , Frederic Lavainne  3 , Giorgina Barbara Piccoli  1
Affiliations

Incremental and Personalized Hemodialysis Start: A New Standard of Care

Massimo Torreggiani et al. Kidney Int Rep. .

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.

Keywords: cost analysis; incremental hemodialysis; personalized hemodialysis; predialysis care; propensity score matching; survival.

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Figures

None
Graphical abstract
Figure 1
Figure 1
(a) Survival of incident hemodialysis patients at Centre Hospitalier Le Mans in the period 2017–2021, according to dialysis schedule. (b) Comparison of survival of incident hemodialysis patients at Centre Hospitalier Le Mans between the period 2017 to 2021 and 2013 to 2015.
Figure 2
Figure 2
(a) Comparison of survival between incident hemodialysis patients at Centre Hospitalier Le Mans in the period 2017 to 2021 and a propensity score-matched cohort from the REIN Registry. 1:1 matching. (b) Comparison of survival between incremental hemodialysis patients at Centre Hospitalier Le Mans in the period 2017 to 2021 and a propensity score-matched cohort from REIN. 1:1 matching. REIN, Renal Epidemiology and Information Network.
Figure 3
Figure 3
Time on incremental dialysis before switching to thrice-weekly dialysis.
See this image and copyright information in PMC

Comment in

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