title: Maintenance of residual renal function 10 years after the start of hemodialysis: the advantage of tailored schedules?
abstract: Maintenance of residual renal clearance is a clinical advantage, protecting against the long-term effects of uremia: although demonstrated in peritoneal dialysis, the strategies in hemodialysis are less clear. This case suggests that dialysis schedules individualized on the basis of renal clearances may help preserve residual function. SB is a 58 year-old male who started dialysis in emergency (creatinine 30.7 mg/dL) in 1993. He had a history of gout, small shrunken kidneys and moderate hypertension. The clinical diagnosis was vasculointerstitial nephropathy. Eighteen months after starting hemodialysis on a conventional thrice weekly schedule, the patient was switched to 2 sessions/week (creatinine clearance increased to 6 ml/min). Thereafter, clearances were checked in alternate months and treatment was tailored to an equivalent renal clearance > or =12 ml/min (1-2 sessions, 2-3.30 hours/week). Ten years after beginning dialysis, he is on a twice weekly schedule (3.30 hours), is normotensive, works full-time and does not want to go on a transplant waiting list.
authors.affiliation: University of Torino, Turin, Italy. gbpiccoli@hotmail.com
authors.forename: G B
authors.initials: GB
authors.lastname: Piccoli
authors.forename: M
authors.initials: M
authors.lastname: Burdese
authors.forename: E
authors.initials: E
authors.lastname: Mezza
authors.forename: V
authors.initials: V
authors.lastname: Consiglio
authors.forename: G
authors.initials: G
authors.lastname: Mangiarotti
authors.forename: A
authors.initials: A
authors.lastname: Thea
authors.forename: F
authors.initials: F
authors.lastname: Bermond
authors.forename: M
authors.initials: M
authors.lastname: Gai
authors.forename: G
authors.initials: G
authors.lastname: Lanfranco
authors.forename: A
authors.initials: A
authors.lastname: Jeantet
authors.forename: G P
authors.initials: GP
authors.lastname: Segoloni
mesh_terms: D001071:Appointments and Schedules; D003404:Creatinine / Q000378:metabolism*; D006801:Humans; D007668:Kidney / Q000378:metabolism* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D013997:Time Factors
chemical_list: D003404:Creatinine