How to perform it ?
Once per week, twice per week, once every 2 weeks?
The idea is : patient is already having UOP, of-course with exclusion of totally anuric, oliguric or HF patients.
Candidates that may benefit from incremental hemodialysis
Good residual renal function with urine output > 0.5 L/d (or KRU>3 ml/min)
Limited fluid retention between two conservative HD treatments with fluid gain < 2.5 kg (or < 5% of ideal dry weight) without HD for 3-4 days
Limited or readily manageable cardiovascular or pulmonary symptoms without clinically significant fluid overload
Suitable body size relative to renal residual kidney function
Hyperphosphatemia (P> 5.5 mEq/L) is infrequent or readily manageable
Good nutrition status
Lack of profound anemia
Infrequent hospitalizations and easily manageable comorbid conditions
Satisfactory health-related quality of life
Use of the criteria on 2x/week HD therapy patients should be re-evaluated once a month.
Article Incremental hemodialysis schedule at the start of renal repl...
Thanks for the criteria, however, i think it should be more individualized per patient general condition, appetite, residual urine volume and residual kidney function, cardiac condition and general well being. What do u think?
Absolutely. It is a tailored therapy and you should re assess frequently (monthly, but depends on type of patient and issues along the way).
It is researchers who believe that HD x3/week is necessary who have the burden of proof. A standard Kt/V of 2.0/ week including GFR is sufficient for all except patients with electrolyte abnormalities or uremic symptoms. The HD is documented as harmful in many ways: cardiac, cerebral, renal.
You forget PD. We usually start our patients on CAPD 2 l x 2.
Thanks James, unfortunately PD is not readily available in Egypt!