Converting from thrice- to twice-weekly maintenance hemodialysis (HD) is feasible for select patients with residual renal function, investigators reported at the 58th European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Congress.

Of 71 patients on thrice-weekly HD, 7 patients (9.8%) met criteria for conversion to a twice-weekly schedule, including a residual renal function exceeding 3 mL/min; urine output greater than 500 mL/d; intradialytic weight gain less than 2.5 kg; hemoglobin greater than 8 g/dL; and manageable serum phosphorus and potassium levels. Patients initiated HD because of symptomatic progression of their chronic kidney disease. Less than half, however, started with a functioning arteriovenous fistula.

Residual renal function of 3 mL/min or higher was maintained for more than 200 days after HD initiation, Abutaleb Ejaz, MD, of the University of Florida, Gainesville, and colleagues reported. The investigators, who advised dietary restrictions, found no significant changes in serum potassium, serum phosphorus, hemoglobin, or parathyroid hormone levels between the twice- and thrice-weekly HD groups. Normalized protein-to-creatinine ratio, albuminuria, and nutrition status were comparable. Dialysis adequacy was maintained.

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Karnofsky Performance Status Scale valuesalso did not differ between groups. Hospital admissions during the study period were no higher for the patients who switched to the twice weekly schedule.

The authors concluded that in a community-based dialysis program, 10% of HD patients qualified for conversion from thrice-weekly to twice-weekly maintenance HD without significant changes to their laboratory or clinical performance measures.

“These observations stimulate discussion regarding increased application of incremental dialysis initiation strategies to preserve residual renal function, increase dialysis-free days, alleviate transportation and care provider-related burden to patients and families, and lower costs,” Dr Ejaz told Renal & Urology News. Hemodialysis compliance was better after the conversion, he noted, and patients reported better quality of life.


Bonagiri P, Owen M, Mohandas S, Sharma S, Ejaz A. Three versus twice-weekly hemodialysis sessions: a community experience. Presented at the 58th ERA-EDTA Congress, June 5-8, 2021. Abstract FC 094.