title: Incremental Hemodialysis: The University of California Irvine Experience.
abstract: Incremental hemodialysis has been examined as a viable hemodialysis regimen for selected end-stage renal disease (ESRD) patients. Preservation of residual kidney function (RKF) has been the driving impetus for this approach given its benefits upon the survival and quality of life of dialysis patients. While clinical practice guidelines recommend an incremental start of dialysis in peritoneal dialysis patients with substantial RKF, there remains little guidance with respect to incremental hemodialysis as an initial renal replacement therapy regimen. Indeed, several large population-based studies suggest that incremental twice-weekly vs. conventional thrice-weekly hemodialysis has favorable impact upon RKF trajectory and survival among patients with adequate renal urea clearance and/or urine output. In this report, we describe a case series of 13 ambulatory incident ESRD patients enrolled in a university-based center's Incremental Hemodialysis Program over the period of January 2015 to August 2016 and followed through December 2016. Among five patients who maintained a twice-weekly hemodialysis schedule vs. eight patients who transitioned to thrice-weekly hemodialysis, we describe and compare patients' longitudinal case-mix, laboratory, and dialysis treatment characteristics over time. The University of California Irvine Experience is the first systemically examined twice-weekly hemodialysis practice in North America. While future studies are needed to refine the optimal approaches and the ideal patient population for implementation of incremental hemodialysis, our case-series serves as a first report of this innovative management strategy among incident ESRD patients with substantial RKF, and a template for implementation of this regimen.
authors.affiliation: Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Ghahremani-Ghajar
authors.affiliation: Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rojas-Bautista
authors.affiliation: Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California.
authors.forename: Wei-Ling
authors.initials: WL
authors.lastname: Lau
authors.affiliation: Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Pahl
authors.affiliation: Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California.
authors.forename: Miguel
authors.initials: M
authors.lastname: Hernandez
authors.affiliation: Nephrology Section, Veterans Affairs Long Beach Health Care System, Long Beach, California.
authors.forename: Anna
authors.initials: A
authors.lastname: Jin
authors.affiliation: Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California.
authors.forename: Uttam
authors.initials: U
authors.lastname: Reddy
authors.affiliation: Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California.
authors.forename: Jason
authors.initials: J
authors.lastname: Chou
authors.affiliation: Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Obi
authors.affiliation: Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California.|Nephrology Section, Veterans Affairs Long Beach Health Care System, Long Beach, California.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.affiliation: Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California.
authors.forename: Connie M
authors.initials: CM
authors.lastname: Rhee
mesh_terms: D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006785:Hospitals, University; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult