Incremental hemodialysis (HD) starting with once-weekly treatment may be feasible for some patients transitioning to renal replacement therapy, according to the authors of a recent review article published in the Journal of Renal Nutrition.
Clinical guidelines have offered limited protocols for incremental HD, and few nations have employed the strategy. Piergiorgio Bolasco, MD, of ASL Cagliari in Italy, and colleagues reviewed studies on the approach. It relies on nutritional management to slow the loss of residual kidney function (RKF) while managing uremic symptoms. The adaptive diet consists of a low protein (0.6 g/Kg/day), low phosphorus, normal-to-high energy diet for non-dialysis days and a high-protein diet for dialysis days. Suitable candidates have only infrequent hyperphosphatemia, hyperkalemia, or mild anemia that is well managed.
“Such an adaptive dietary regimen may elicit more favorable outcomes including better preserved RKF, lower β2-microglobulin levels, improved phosphorus control, and lower doses of erythropoiesis-stimulating agents,” Dr Bolasco and fellow investigators stated.
Clinicians need to monitor patients’ clinical and nutritional status and RKF before and during the transitions to once-, then twice-weekly HD, and eventually thrice-weekly HD. “Careful clinical monitoring and appropriate dietary interventions are essential for the safety and optimization of infrequent hemodialysis schedules,” Dr Bolasco and colleagues stressed.
1. 1. Bolasco P Cupisti A, Locatelli F, Caria S, Kalantar-Zadeh K. Dietary Management of Incremental Transition to Dialysis Therapy: Once-Weekly Hemodialysis Combined With Low-Protein Diet. J Ren Nutr. doi: 10.1053/j.jrn.2016.01.015.