Tailoring dialysis and resuming low-protein diets may favor chronic dialysis discontinuation: report on three cases.
Renal function recovery (RFR), defined as the discontinuation of dialysis after 3 months of replacement therapy, is reported in about 1% of chronic dialysis patients. The role of personalized, intensive dialysis schedules and of resuming low-protein diets has not been studied to date. This report describes three patients with RFR who were recently treated at a new dialysis unit set up to offer intensive hemodialysis. All three patients were females, aged 73, 75, and 78 years. Kidney disease included vascular-cholesterol emboli, diabetic nephropathy and vascular and dysmetabolic disease. At time of RFR, the patients had been dialysis-dependent from 3 months to 1 year. Dialysis was started with different schedules and was progressively discontinued with a "decremental" policy, progressively decreasing number and duration of the sessions. A moderately restricted low-protein diet (proteins 0.6 g/kg/day) was started immediately after dialysis discontinuation. The most recent update showed that two patients are well off dialysis for 5 and 6 months; the diabetic patient died (sudden death) 3 months after dialysis discontinuation. Within the limits of small numbers, our case series may suggest a role for personalized dialysis treatments and for including low-protein diets in the therapy, in enhancing long-term RFR in elderly dialysis patients.
SS Nephrology ASOU San Luigi, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.
Giorgina Barbara
GB
Piccoli
Gabriella
G
Guzzo
Federica Neve
FN
Vigotti
Irene
I
Capizzi
Roberta
R
Clari
Stefania
S
Scognamiglio
Valentina
V
Consiglio
Emiliano
E
Aroasio
Silvana
S
Gonella
Andrea
A
Veltri
Paolo
P
Avagnina
D000368:Aged; D018753:Diet, Protein-Restricted; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000178:diet therapy / Q000628:therapy*; D006435:Renal Dialysis / Q000379:methods*
Personalized hemodialysis schedules; decremental dialysis; dialysis efficiency; low-protein diets