- Email: [email protected]
Once-Weekly Hemodialysis: A Single-Center Experience
Correspondence speaking at a meeting. The other authors declare that they have no relevant financial interests.
References 1. Wetzels JFM, van de Kar NCAJ. Discontinuation of eculizumab maintenance treatment for atypical hemolytic uremic syndrome. Am J Kidney Dis. 2015;65(2):342. 2. Ardissino G, Testa S, Possenti I, et al. Discontinuation of eculizumab maintenance treatment for atypical hemolytic uremic syndrome: a report of 10 cases. Am J Kidney Dis. 2014;64(4): 633-637.
than in those who initiated HD once weekly (ie, including those who were later switched to 33/wk HD; Table 1). These data suggest that incremental HD could be a suitable approach in selected patients. Carmelo Libetta, MD, Pasquale Esposito, MD, PhD Antonio Dal Canton, MD Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy Corresponding author: [email protected]
Acknowledgements Support: None. Financial Disclosure: The authors declare that they have no relevant financial interests.
Ó 2015 by the National Kidney Foundation, Inc. http://dx.doi.org/10.1053/j.ajkd.2014.05.028
References
Once-Weekly Hemodialysis: A SingleCenter Experience To the Editor: In a recent AJKD article, Kalantar-Zadeh et al1 discussed the appropriateness of twice-weekly and incremental hemodialysis (HD) as approaches for initiating renal replacement therapy. We report our experience with 13/wk HD, which we routinely prescribe in uremic patients who have residual urine output . 1 L/d and lack signs of fluid overload. We compared 8 incident HD patients (aged 68.5 6 7.1 years) considered eligible for 13/wk HD with 8 age-matched incident patients (aged 69.3 6 8.2 years) undergoing standard 33/wk HD over a 12-month follow-up. Each patient provided written consent. The 13/wk HD treatment consisted of a 4-hour, high-efficiency, euvolemic HD session. Residual kidney function and serum C-reactive protein (CRP), albumin, and b2-microglobulin (B2M) were measured prior to initiating HD treatment and monthly thereafter. Health-related quality of life was evaluated every 3 months using KDQOL-36 (the Kidney Disease Quality of Life 36-item survey).2,3 There was no significant difference in albumin or CRP levels between groups during the study period (both at baseline and during the follow-up). However, B2M levels were significantly higher in 33/wk compared with 13/wk HD patients (32.6 6 2.7 vs 17.4 6 1.9 mg/L at 6 months and 35.1 6 2.8 vs 19.4 6 2.1 mg/ L at 12 months; P , 0.05). During follow-up, 5 patients were switched from 13/wk to 33/ wk HD due to reduced residual kidney function (median technique survival of 9 months). Interestingly, at each follow-up evaluation, KDQOL-36 scores were significantly lower in 33/wk HD patients
1. Kalantar-Zadeh K, Unruh M, Zager PG, et al. Twice-weekly and incremental hemodialysis treatment for initiation of kidney replacement therapy. Am J Kidney Dis. 2014;64(2):181-186. 2. Merkus MP, Jager KJ, Dekker FW, Boeschoten EW, Stevens P, Krediet RT. Quality of life in patients on chronic dialysis: self-assessment 3 months after the start of treatment. The Necosad Study Group. Am J Kidney Dis. 1997;29(4):584-592. 3. Klersy C, Callegari A, Giorgi I, Sepe V, Efficace E, Politi P; Pavia Working Group on QoL in Organ Transplant. Italian translation, cultural adaptation and validation of KDQOL-SF, version 1.3, in patients with severe renal failure. J Nephrol. 2007;20(1):43-51. Kalantar-Zadeh et al thank the correspondents for these comments. Ó 2015 by the National Kidney Foundation, Inc. http://dx.doi.org/10.1053/j.ajkd.2014.07.034
Compensation and Incentives for Living Organ Donors: A Double-Edged Sword That May Resolve the Current Organ Shortage Crisis To the Editor: We read with interest the article by Tong et al1 on the range of opinions of transplant physicians on financial incentives in living kidney donation. Although the article provides valuable observations, the study population of nephrologists and surgeons was small
Table 1. Overall Health Score and Residual Kidney Function in Patients, by Dialysis Frequency Residual Kidney Functiona
Overall Health Score
Initiated on 13/wk HDb Stable on 33/wk HD Stable on 13/wk HD Switched From 13 to 33/wk HD Stable on 33/wk HD No. of patients Baseline
8
8
3
5
8
72.2 6 9.9
66.4 6 12.7
10.1 6 0.8
9.1 6 0.9
4.9 6 1.2c
3-mo follow-up
72.8 6 8.7
62.1 6 10.9c
9.7 6 0.7
5.5 6 1.9d
3.3 6 0.8
6-mo follow-up
71.4 6 11.0
58.9 6 10.2c
9.0 6 0.5
1.9 6 1.8d
1.4 6 0.9
9-mo follow-up
71.9 6 10.8
54.7 6 13.8c
8.6 6 0.4
0.6 6 1.3d
0
12-mo follow-up
70.0 6 12.5
56.8 6 0.9c
7.8 6 0.8
0
0
Note: Except where indicated, values are given as mean 6 standard deviation. Health score was evaluated by KDQOL-36 questionnaire (Italian version 1.33). a Expressed as mL/min/1.73 m2 and estimated as the mean of urea and creatinine clearances. b Includes 5 patients who switched to 33/wk HD during follow-up. c P , 0.05 versus 13/wk HD. d P , 0.05 versus patients still receiving 13/wk HD after 12 months of follow-up.
Am J Kidney Dis. 2015;65(2):342-347
343
References 1. Wetzels JFM, van de Kar NCAJ. Discontinuation of eculizumab maintenance treatment for atypical hemolytic uremic syndrome. Am J Kidney Dis. 2015;65(2):342. 2. Ardissino G, Testa S, Possenti I, et al. Discontinuation of eculizumab maintenance treatment for atypical hemolytic uremic syndrome: a report of 10 cases. Am J Kidney Dis. 2014;64(4): 633-637.
than in those who initiated HD once weekly (ie, including those who were later switched to 33/wk HD; Table 1). These data suggest that incremental HD could be a suitable approach in selected patients. Carmelo Libetta, MD, Pasquale Esposito, MD, PhD Antonio Dal Canton, MD Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy Corresponding author: [email protected]
Acknowledgements Support: None. Financial Disclosure: The authors declare that they have no relevant financial interests.
Ó 2015 by the National Kidney Foundation, Inc. http://dx.doi.org/10.1053/j.ajkd.2014.05.028
References
Once-Weekly Hemodialysis: A SingleCenter Experience To the Editor: In a recent AJKD article, Kalantar-Zadeh et al1 discussed the appropriateness of twice-weekly and incremental hemodialysis (HD) as approaches for initiating renal replacement therapy. We report our experience with 13/wk HD, which we routinely prescribe in uremic patients who have residual urine output . 1 L/d and lack signs of fluid overload. We compared 8 incident HD patients (aged 68.5 6 7.1 years) considered eligible for 13/wk HD with 8 age-matched incident patients (aged 69.3 6 8.2 years) undergoing standard 33/wk HD over a 12-month follow-up. Each patient provided written consent. The 13/wk HD treatment consisted of a 4-hour, high-efficiency, euvolemic HD session. Residual kidney function and serum C-reactive protein (CRP), albumin, and b2-microglobulin (B2M) were measured prior to initiating HD treatment and monthly thereafter. Health-related quality of life was evaluated every 3 months using KDQOL-36 (the Kidney Disease Quality of Life 36-item survey).2,3 There was no significant difference in albumin or CRP levels between groups during the study period (both at baseline and during the follow-up). However, B2M levels were significantly higher in 33/wk compared with 13/wk HD patients (32.6 6 2.7 vs 17.4 6 1.9 mg/L at 6 months and 35.1 6 2.8 vs 19.4 6 2.1 mg/ L at 12 months; P , 0.05). During follow-up, 5 patients were switched from 13/wk to 33/ wk HD due to reduced residual kidney function (median technique survival of 9 months). Interestingly, at each follow-up evaluation, KDQOL-36 scores were significantly lower in 33/wk HD patients
1. Kalantar-Zadeh K, Unruh M, Zager PG, et al. Twice-weekly and incremental hemodialysis treatment for initiation of kidney replacement therapy. Am J Kidney Dis. 2014;64(2):181-186. 2. Merkus MP, Jager KJ, Dekker FW, Boeschoten EW, Stevens P, Krediet RT. Quality of life in patients on chronic dialysis: self-assessment 3 months after the start of treatment. The Necosad Study Group. Am J Kidney Dis. 1997;29(4):584-592. 3. Klersy C, Callegari A, Giorgi I, Sepe V, Efficace E, Politi P; Pavia Working Group on QoL in Organ Transplant. Italian translation, cultural adaptation and validation of KDQOL-SF, version 1.3, in patients with severe renal failure. J Nephrol. 2007;20(1):43-51. Kalantar-Zadeh et al thank the correspondents for these comments. Ó 2015 by the National Kidney Foundation, Inc. http://dx.doi.org/10.1053/j.ajkd.2014.07.034
Compensation and Incentives for Living Organ Donors: A Double-Edged Sword That May Resolve the Current Organ Shortage Crisis To the Editor: We read with interest the article by Tong et al1 on the range of opinions of transplant physicians on financial incentives in living kidney donation. Although the article provides valuable observations, the study population of nephrologists and surgeons was small
Table 1. Overall Health Score and Residual Kidney Function in Patients, by Dialysis Frequency Residual Kidney Functiona
Overall Health Score
Initiated on 13/wk HDb Stable on 33/wk HD Stable on 13/wk HD Switched From 13 to 33/wk HD Stable on 33/wk HD No. of patients Baseline
8
8
3
5
8
72.2 6 9.9
66.4 6 12.7
10.1 6 0.8
9.1 6 0.9
4.9 6 1.2c
3-mo follow-up
72.8 6 8.7
62.1 6 10.9c
9.7 6 0.7
5.5 6 1.9d
3.3 6 0.8
6-mo follow-up
71.4 6 11.0
58.9 6 10.2c
9.0 6 0.5
1.9 6 1.8d
1.4 6 0.9
9-mo follow-up
71.9 6 10.8
54.7 6 13.8c
8.6 6 0.4
0.6 6 1.3d
0
12-mo follow-up
70.0 6 12.5
56.8 6 0.9c
7.8 6 0.8
0
0
Note: Except where indicated, values are given as mean 6 standard deviation. Health score was evaluated by KDQOL-36 questionnaire (Italian version 1.33). a Expressed as mL/min/1.73 m2 and estimated as the mean of urea and creatinine clearances. b Includes 5 patients who switched to 33/wk HD during follow-up. c P , 0.05 versus 13/wk HD. d P , 0.05 versus patients still receiving 13/wk HD after 12 months of follow-up.
Am J Kidney Dis. 2015;65(2):342-347
343