Introduction:
Frequency of hemodialysis is still a debatable topic. Incremental hemodialysis has gained popularity and requires a smooth increase in dialysis frequency while maintaining a sufficient residual diuresis. The majority of patients on maintenance hemodialysis in developed countries are administered a relatively uniform regimen, with a 3 HD/week schedule and a full dose, to achieve a minimum single pool Kt/V urea (spKt/V urea) ≥ 1.2. In developing countries and some developed countries, a twice-weekly schedule independent of residual kidney function is still performed, sometimes because of lack of resources and some other times because of patients’ resistance to undergo three sessions per week. The frequency of maintenance hemodialysis is associated with patient survival.
The aim of our study is to compare twice weekly and thrice weekly hemodialysis patients in terms of hospitalization and survival
Methods:
Our study is a single center prospective observational study carried out in Gauhati Medical College and Hospital, Guwahati, Assam, India for a period of one year from May 2023 to April 2024. The enrolled patients were categorized into Group I, twice-weekly HD patients and Group II, thrice-weekly HD patients. Demographics, comorbidities, baseline laboratory tests, antihypertensive medications, residual diuresis, vascular access and dialysis prescription were collected from the patients' medical records. Patients were followed up at 3 monthly intervals for their hospitalizations for pulmonary edema, hyperkalemia, uncontrolled severe hypertension and erythropoietin (EPO) dose requirement and mortality.
Results:
A total of 294 patients were included in our study. 34 patients were in the thrice-weekly group and 260 patients in the twice-weekly group. Mean age was 55.3 years, 63% and 37% were males and females respectively. Most of the patients had diabetes (58.5%) and 42.8% had coronary artery disease. Mean eGFR at dialysis initiation was 7.4 mL/min/1.73 m2. Baseline mean hemoglobin was 6.85 g/dL. 41.8% were initiated with AV fistula with more patients in the twice-weekly initiated with temporary catheter. Residual diuresis was significantly higher in twice-weekly versus thrice-weekly at one year. 19.04% of patients on thrice-weekly did not need antihypertensive medications at one year versus 14% in the twice-weekly. There was no difference in hospitalizations’ rates between the two groups and no survival difference between the two groups.
Conclusions:
Our study showed that patients on twice-weekly hemodialysis had a similar survival and hospitalizations’ rates at one year as patients on thrice-weekly hemodialysis. However, a twice-weekly schedule was accompanied with more antihypertensive therapy despite more preserved residual diuresis.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.