title: Dietary Management of Incremental Transition to Dialysis Therapy: Once-Weekly Hemodialysis Combined With Low-Protein Diet.
abstract: Initiation of thrice-weekly hemodialysis often results in a rapid loss of residual kidney function (RKF) including reduction in urine output. Preserving RKF longer is associated with better outcomes including greater survival in dialysis patients. An alternative approach aimed at preserving RKF is an incremental transition with less frequent hemodialysis sessions at the beginning with gradual increase in hemodialysis frequency over months. In addition to favorable clinical and economic implications, an incremental transition would also enhance a less stressful adaptation of the patient to dialysis therapy. The current guidelines provide only limited recommendations for incremental hemodialysis approach, whereas the potential role of nutritional management of newly transitioned hemodialysis patients is largely overlooked. We have reviewed previous reports and case studies of once-weekly hemodialysis treatment combined with low-protein, low-phosphorus, and normal-to-high-energy diet especially for nondialysis days, whereas on dialysis days, high protein can be provided. Such an adaptive dietary regimen may elicit more favorable outcomes including better preserved RKF, lower β2-microglobulin levels, improved phosphorus control, and lower doses of erythropoiesis-stimulating agents. Clinical and nutritional status and RKF should be closely monitored throughout the transition to once and then twice-weekly regimen and eventually thrice-weekly hemodialysis. Further studies are needed to verify the long-term safety and implications of this approach to dialysis transition.
authors.affiliation: Department of Territorial Nephrology and Dialysis Unit, ASL Cagliari, Italy. Electronic address: pg.bolasco@tin.it.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Bolasco
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Adamasco
authors.initials: A
authors.lastname: Cupisti
authors.affiliation: Department of Nephrology, Alessandro Manzoni Hospital, Lecco, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Locatelli
authors.affiliation: Department of Territorial Nephrology and Dialysis Unit, ASL Cagliari, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Caria
authors.affiliation: Division of Nephrology and Hypertension, School of Medicine, University of California, Irvine, Orange, California.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
mesh_terms: D018753:Diet, Protein-Restricted; D006801:Humans; D007676:Kidney Failure, Chronic; D010758:Phosphorus; D016226:Phosphorus, Dietary; D006435:Renal Dialysis
chemical_list: D016226:Phosphorus, Dietary; D010758:Phosphorus