dc.contributor.author | Kaja Kamal, Raja Mohammed | |
dc.contributor.author | Farrington, Ken | |
dc.contributor.author | Busby, Amanda D | |
dc.contributor.author | Wellsted, David | |
dc.contributor.author | Chandna, Humza | |
dc.contributor.author | Mawer, Laura J | |
dc.contributor.author | Sridharan, Sivakumar | |
dc.contributor.author | Vilar, Enric | |
dc.date.accessioned | 2019-02-05T10:30:08Z | |
dc.date.available | 2019-02-05T10:30:08Z | |
dc.date.issued | 2018-10-23 | |
dc.identifier.citation | Kaja Kamal , R M , Farrington , K , Busby , A D , Wellsted , D , Chandna , H , Mawer , L J , Sridharan , S & Vilar , E 2018 , ' Initiating haemodialysis twice-weekly as part of an incremental programme may protect residual kidney function ' , Nephrology Dialysis Transplantation , pp. 1-9 . https://doi.org/10.1093/ndt/gfy321 | |
dc.identifier.issn | 0931-0509 | |
dc.identifier.other | ORCID: /0000-0002-0545-0276/work/133568259 | |
dc.identifier.other | ORCID: /0000-0002-2895-7838/work/106342673 | |
dc.identifier.uri | http://hdl.handle.net/2299/21030 | |
dc.description | © The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. | |
dc.description.abstract | Background: Initiating twice-weekly haemodialysis (2×HD) in patients who retain significant residual kidney function (RKF) may have benefits. We aimed to determine differences between patients initiated on twice- and thrice-weekly regimes, with respect to loss of kidney function, survival and other safety parameters. Methods: We conducted a single-centre retrospective study of patients initiating dialysis with a residual urea clearance (KRU) of ≥3 mL/min, over a 20-year period. Patients who had 2×HD for ≥3 months during the 12 months following initiation of 2×HD were identified for comparison with those dialysed thrice-weekly (3×HD). Results: The 2×HD group consisted of 154 patients, and the 3×HD group 411 patients. The 2×HD patients were younger (59 ± 15 versus 62 ± 15 years: P = 0.014) and weighed less (70 ± 16 versus 80 ± 18 kg: P < 0.001). More were females (34% versus 27%: P = 0.004). Fewer had diabetes (25% versus 34%: P = 0.04) and peripheral vascular disease (PVD) (13% versus 23%: P = 0.008). Baseline KRU was similar in both groups (5.3 ± 2.4 for 2 × HD versus 5.1 ± 2.8 mL/min for 3 × HD: P = 0.507). In a mixed effects model correcting for between-group differences in comorbidities and demographics, 3×HD was associated with increased rate of loss of KRU and separation of KRU. In separate mixed effects models, group (2×HD versus 3×HD) was not associated with differences in serum potassium or phosphate, and the groups did not differ with respect to total standard Kt/V. Survival, adjusted for age, gender, weight, baseline KRU and comorbidity (prevalence of diabetes, cardiac disease, PVD and malignancy) was greater in the 2×HD group (hazard ratio 0.755: P = 0.044). In sub-analyses, the survival benefit was confined to women, and those of less than median bodyweight. Conclusion: 2×HD initiation as part of an incremental programme with regular monthly monitoring of KRU was safe and associated with a reduced rate of loss of RKF early after dialysis initiation and improved survival. Randomized controlled trials of this approach are indicated. | en |
dc.format.extent | 9 | |
dc.format.extent | 391754 | |
dc.language.iso | eng | |
dc.relation.ispartof | Nephrology Dialysis Transplantation | |
dc.title | Initiating haemodialysis twice-weekly as part of an incremental programme may protect residual kidney function | en |
dc.contributor.institution | Basic and Clinical Science Unit | |
dc.contributor.institution | Centre for Health Services and Clinical Research | |
dc.contributor.institution | School of Life and Medical Sciences | |
dc.contributor.institution | Department of Psychology and Sports Sciences | |
dc.contributor.institution | Health Research Methods Unit | |
dc.contributor.institution | Centre for Research in Psychology and Sport Sciences | |
dc.contributor.institution | Department of Pharmacy, Pharmacology and Postgraduate Medicine | |
dc.description.status | Peer reviewed | |
dc.date.embargoedUntil | 2019-10-23 | |
rioxxterms.versionofrecord | 10.1093/ndt/gfy321 | |
rioxxterms.type | Journal Article/Review | |
herts.preservation.rarelyaccessed | true | |