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The debate regarding the optimum frequency of hemodialysis (HD) has become more nuanced in the recent years. Thrice weekly (3W) HD is traditionally preferred. In incremental HD, patients with higher residual kidney function (RKF) is usually started on twice weekly (2W) HD. In Bangladesh, however, owing to financial constraints, most patients start and continue 2W HD regardless of the baseline RKF.
This cross-sectional study was performed in 3 HD centers across Bangladesh – 2 from urban and one from rural area. Data was collected from patients on HD for at least 3 months during May – June, 2023. Data was analyzed by statistical analysis software (SAS) studio.
Data was collected from 501 patients. Mean age of the patients was 51.5 (±13) years. Of the 501 patients, 250 were female (50%) and 237 were diabetic (48.3%). 403 (80.4%) of the patients were from an urban setting, 70 (13.8%) were employed. 364 (75%) of all patients took 2W HD, rest took thrice-weekly HD. Patients on 3W HD were on HD for a significantly longer period (36.5 vs 21.6 months, p<0.0001). They were also predominantly female (62.6% vs 45.9%, p=0.001), from an urban setting (95.1% vs 76.9%, p<0.0001) and consisted of more graduates (46.7% vs 35.7%, p=0.03). Age, employment status and monthly family income however did not vary between the 2 groups.
The 2W and 3W HD groups did not differ in terms of diabetes mellitus (DM) and hypertension. More patients in the 3W group seemed to experience MI and stroke episodes (8.3% vs 3.7%, p=0.04; 9.8% vs 4.5%, p=0.03). Consequently, a univariate logistic regression model showed that the 3W group had 2.3 times higher odds of experiencing a cardiovascular event (CVE) (p=0.007). However, when controlled for duration on HD, the effect disappeared (p=0.07), indicating that the 2 groups did not differ significantly in terms of major CVE rates.
Comparison of a single HD session showed that the interdialytic weight gain, ultrafiltration volume and blood flow rate did not vary significantly, indicating possible retention of residual renal function in the 2W group. The single pool Kt/V was also similar. Pre-HD mean arterial pressure however was significantly higher in the 2W group (104.2 mmHg vs 100.4 mmHg, p = 0.005), indicating a possible volume overload.
Comparison of biochemical parameters show that the 2W group had significantly lower hemoglobin (8.6 vs 9.1 g/dl, p=0.001) and cholesterol (4 vs 4.4 mmol/l, p=0.002), but higher potassium (5.2 vs 5 mmol/l, p=0.03), bicarbonate (23.6 vs 22.8 mEq/l, p=0.01) and pre-HD urea (21.7 vs 19.4 mmol/l, p=0.01). Serum levels of ferritin, albumin, corrected calcium, phosphate and intact parathyroid hormone were not significantly different.
2W HD patients had comparable cardiovascular event rates, HD adequacy and other parameters and CKD-MBD status. They had higher blood pressure, potassium and acidosis lower hemoglobin level compared to the 3W HD patients. Overall they can be a viable and cheaper alternative in a resource-poor setting.