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The incremental treatment of ESRD: a low-protein diet combined with weekly hemodialysis may be beneficial for selected patients.

Caria S, Cupisti A, Sau G, Bolasco P - BMC Nephrol (2014)

Bottom Line: The cost per patient per year resulted significantly lower in CDDP than in THD Group.CDDP was also associated with a lower hospitalization rate and reduced need of erythropoietin, as well as of drugs used for treatment of calcium-phosphate abnormalities, thus leading to a significant cost-saving.We concluded that in selected ESRD patients with preserved urine output attitude to protein restriction, CDDP may be a beneficial choice for an incremental hemodialysis program.

View Article: PubMed Central - PubMed

Affiliation: Nephrology and Dialysis Unit, ASL 8 Cagliari, Italy. cariastefan@tiscali.it.

ABSTRACT

Background: Infrequent dialysis, namely once-a-week session combined with very low-protein, low-phosphorus diet supplemented with ketoacids was reported as a useful treatment schedule for ESRD patients with markedly reduced residual renal function but preserved urine output. This study reports our findings from the application of a weekly dialysis schedule plus less severe protein restriction (standard low-protein low-phosphorus diet) in stage 5 CKD patients with consistent dietary discipline.

Methods: This is a multicenter, prospective controlled study, including 68 incident CKD patients followed in a pre-dialysis clinic with Glomerular Filtration Rate 5 to 10 ml/min/1.73/ m2 who became unstable on the only medical treatment. They were offered to begin a Combined Diet Dialysis Program (CDDP) or a standard thrice-a-week hemodialysis (THD): 38 patients joined the CDDP, whereas 30 patients chose THD. Patients were studied at baseline, 6 and 12 months; hospitalization and survival rate were followed-up for 24 months.

Results: Volume output and residual renal function were maintained in the CDDP Group while those features dropped quickly in THD Group. Throughout the study, CDDP patients had a lower erythropoietin resistance index, lower β2 microglobulin levels and lower need for cinacalcet of phosphate binders than THD, and stable parameters of nutritional status. At 24 month follow-up, 39.4% of patients were still on CDDP; survival rates were 94.7% and 86.8% for CDDP and THD patients, respectively, but hospitalization rate was much higher in THD than in CDDP patients. The cost per patient per year resulted significantly lower in CDDP than in THD Group.

Conclusions: This study shows that a CDDP served to protect the residual renal function, to maintain urine volume output and to preserve a good nutritional status. CDDP also blunted the rapid β2 microglobulin increase and resulted in better control of anemia and calcium-phosphate abnormalities. CDDP was also associated with a lower hospitalization rate and reduced need of erythropoietin, as well as of drugs used for treatment of calcium-phosphate abnormalities, thus leading to a significant cost-saving. We concluded that in selected ESRD patients with preserved urine output attitude to protein restriction, CDDP may be a beneficial choice for an incremental hemodialysis program.

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Related in: MedlinePlus

Changes in urine volume (a), serum albumin (b), β2-microglobulin (c) and serum phosphorus (d) in CDDP Group (dotted Line) and THD Group (full line), at baseline, 6 and 12 months of follow-up.
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Fig1: Changes in urine volume (a), serum albumin (b), β2-microglobulin (c) and serum phosphorus (d) in CDDP Group (dotted Line) and THD Group (full line), at baseline, 6 and 12 months of follow-up.

Mentions: During the study period, GFR was preserved in CDDP patients in comparison to THD group (Table 2). GFR loss progression was very low in the former (-0.13 ml/min/month) while it was faster in the latter (-1.53 ml/min/month). Similarly, in the CDDP group an effective urine volume output was maintained whereas it dramatically dropped in the THD patients (Figure 1a). As a consequence, the interdialytic weight gain in CDDP patients was limited to (800 ± 300 g) per week. The dosage of frusemide increased from 150 ± 154 to 273 ± 201 mg/day in the CDDP group, and from 332 ± 171 to 409 ± 205 mg/day (p =0.003) in the THD group. The increase of β2-microglobulin circulating levels was much lower in CDDP than in THD patients (+11.2% vs +34%, respectively) (Figure 1c).Table 2


The incremental treatment of ESRD: a low-protein diet combined with weekly hemodialysis may be beneficial for selected patients.

Caria S, Cupisti A, Sau G, Bolasco P - BMC Nephrol (2014)

Changes in urine volume (a), serum albumin (b), β2-microglobulin (c) and serum phosphorus (d) in CDDP Group (dotted Line) and THD Group (full line), at baseline, 6 and 12 months of follow-up.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4232716&req=5

Fig1: Changes in urine volume (a), serum albumin (b), β2-microglobulin (c) and serum phosphorus (d) in CDDP Group (dotted Line) and THD Group (full line), at baseline, 6 and 12 months of follow-up.
Mentions: During the study period, GFR was preserved in CDDP patients in comparison to THD group (Table 2). GFR loss progression was very low in the former (-0.13 ml/min/month) while it was faster in the latter (-1.53 ml/min/month). Similarly, in the CDDP group an effective urine volume output was maintained whereas it dramatically dropped in the THD patients (Figure 1a). As a consequence, the interdialytic weight gain in CDDP patients was limited to (800 ± 300 g) per week. The dosage of frusemide increased from 150 ± 154 to 273 ± 201 mg/day in the CDDP group, and from 332 ± 171 to 409 ± 205 mg/day (p =0.003) in the THD group. The increase of β2-microglobulin circulating levels was much lower in CDDP than in THD patients (+11.2% vs +34%, respectively) (Figure 1c).Table 2

Bottom Line: The cost per patient per year resulted significantly lower in CDDP than in THD Group.CDDP was also associated with a lower hospitalization rate and reduced need of erythropoietin, as well as of drugs used for treatment of calcium-phosphate abnormalities, thus leading to a significant cost-saving.We concluded that in selected ESRD patients with preserved urine output attitude to protein restriction, CDDP may be a beneficial choice for an incremental hemodialysis program.

View Article: PubMed Central - PubMed

Affiliation: Nephrology and Dialysis Unit, ASL 8 Cagliari, Italy. cariastefan@tiscali.it.

ABSTRACT

Background: Infrequent dialysis, namely once-a-week session combined with very low-protein, low-phosphorus diet supplemented with ketoacids was reported as a useful treatment schedule for ESRD patients with markedly reduced residual renal function but preserved urine output. This study reports our findings from the application of a weekly dialysis schedule plus less severe protein restriction (standard low-protein low-phosphorus diet) in stage 5 CKD patients with consistent dietary discipline.

Methods: This is a multicenter, prospective controlled study, including 68 incident CKD patients followed in a pre-dialysis clinic with Glomerular Filtration Rate 5 to 10 ml/min/1.73/ m2 who became unstable on the only medical treatment. They were offered to begin a Combined Diet Dialysis Program (CDDP) or a standard thrice-a-week hemodialysis (THD): 38 patients joined the CDDP, whereas 30 patients chose THD. Patients were studied at baseline, 6 and 12 months; hospitalization and survival rate were followed-up for 24 months.

Results: Volume output and residual renal function were maintained in the CDDP Group while those features dropped quickly in THD Group. Throughout the study, CDDP patients had a lower erythropoietin resistance index, lower β2 microglobulin levels and lower need for cinacalcet of phosphate binders than THD, and stable parameters of nutritional status. At 24 month follow-up, 39.4% of patients were still on CDDP; survival rates were 94.7% and 86.8% for CDDP and THD patients, respectively, but hospitalization rate was much higher in THD than in CDDP patients. The cost per patient per year resulted significantly lower in CDDP than in THD Group.

Conclusions: This study shows that a CDDP served to protect the residual renal function, to maintain urine volume output and to preserve a good nutritional status. CDDP also blunted the rapid β2 microglobulin increase and resulted in better control of anemia and calcium-phosphate abnormalities. CDDP was also associated with a lower hospitalization rate and reduced need of erythropoietin, as well as of drugs used for treatment of calcium-phosphate abnormalities, thus leading to a significant cost-saving. We concluded that in selected ESRD patients with preserved urine output attitude to protein restriction, CDDP may be a beneficial choice for an incremental hemodialysis program.

Show MeSH
Related in: MedlinePlus