title: Comparison of Clinical Outcome Between Twice-Weekly and Thrice-Weekly Hemodialysis in Patients With Residual Kidney Function.
abstract: Residual kidney function (RKF) contributes to improved survival in hemodialysis (HD) patients. However, it is not clear whether RKF allows a comparable survival rate in patients undergoing twice-weekly HD compared with thrice-weekly HD.We enrolled 685 patients from a prospective multicenter observational cohort. RKF and HD adequacy was monitored regularly over 3-year follow-up. Patients with RKF were divided into groups undergoing twice-weekly HD (n = 113) or thrice-weekly HD (n = 137). Patients without RKF undergoing thrice-weekly HD (n = 435) were included as controls. Fluid balance and dialysis-associated characteristics were followed and clinical outcomes evaluated using all-cause mortality and cardiovascular events (CVE).In patients with RKF, baseline and follow-up RKF were significantly higher in patients undergoing twice-weekly HD than in those undergoing thrice-weekly HD. Total Kt/V urea (dialysis plus residual renal) in patients with RKF undergoing twice-weekly HD was greater than or equal to those in patients with or without RKF undergoing thrice-weekly HD. Compared with patients with RKF undergoing thrice-weekly HD, patients with RKF undergoing twice-weekly HD had no fluid excess, but their normalized protein catabolic rate became lower since 24-month follow up. In multivariable analyses, patients with RKF undergoing twice-weekly HD had a noninferior risk of mortality (hazard ratio [HR], 0.83; 95% confidence interval [95% CI], 0.34-2.01, P = 0.68) and of CVE (HR, 0.60; 95% CI, 0.28-1.29, P = 0.19) compared with patients without RKF undergoing thrice-weekly HD. However, this group showed an independent association with a greater risk of mortality compared with patients with RKF undergoing thrice-weekly HD (HR, 4.20; 95% CI, 1.02-17.32, P = 0.04).In conclusion, patients with RKF undergoing twice-weekly HD had an increased risk of mortality compared with those undergoing thrice-weekly HD. Decisions about twice-weekly HD should consider not only RKF, but also other risk factors such as normalized protein catabolic rate.
authors.affiliation: From the Department of Internal Medicine, College of Medicine, The Catholic University of Korea (HSH, YAH, HEY, YKC, SYK, YOK, DCJ, YKK, CWY); Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul (S-HK); Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu (YLK); Department of Internal Medicine, College of Medicine, Seoul National University (YSK); Department of Internal Medicine, College of Medicine, Yonsei University, Seoul (SWK); and Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea (NHK).
authors.forename: Hyeon Seok
authors.initials: HS
authors.lastname: Hwang
authors.forename: Yoo Ah
authors.initials: YA
authors.lastname: Hong
authors.forename: Hye Eun
authors.initials: HE
authors.lastname: Yoon
authors.forename: Yoon Kyung
authors.initials: YK
authors.lastname: Chang
authors.forename: Suk Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Young Ok
authors.initials: YO
authors.lastname: Kim
authors.forename: Dong Chan
authors.initials: DC
authors.lastname: Jin
authors.forename: Su-Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Yong-Lim
authors.initials: YL
authors.lastname: Kim
authors.forename: Yon-Su
authors.initials: YS
authors.lastname: Kim
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
authors.forename: Nam-Ho
authors.initials: NH
authors.lastname: Kim
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011506:Proteins / Q000378:metabolism; D012042:Registries; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D056910:Republic of Korea / Q000453:epidemiology; D014882:Water-Electrolyte Balance
chemical_list: D011506:Proteins