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The incremental treatment of ESRD: a low-protein diet combined with weekly hemodialysis may be beneficial for selected patients.
BMC Nephrol. 2014 Oct 29; 15:172.BN

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.

Authors+Show Affiliations

Nephrology and Dialysis Unit, ASL 8 Cagliari, Italy. cariastefan@tiscali.it.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Controlled Clinical Trial
Journal Article
Multicenter Study

Language

eng

PubMed ID

25352299

Citation

Caria, Stefania, et al. "The Incremental Treatment of ESRD: a Low-protein Diet Combined With Weekly Hemodialysis May Be Beneficial for Selected Patients." BMC Nephrology, vol. 15, 2014, p. 172.
Caria S, Cupisti A, Sau G, et al. The incremental treatment of ESRD: a low-protein diet combined with weekly hemodialysis may be beneficial for selected patients. BMC Nephrol. 2014;15:172.
Caria, S., Cupisti, A., Sau, G., & Bolasco, P. (2014). The incremental treatment of ESRD: a low-protein diet combined with weekly hemodialysis may be beneficial for selected patients. BMC Nephrology, 15, 172. https://doi.org/10.1186/1471-2369-15-172
Caria S, et al. The Incremental Treatment of ESRD: a Low-protein Diet Combined With Weekly Hemodialysis May Be Beneficial for Selected Patients. BMC Nephrol. 2014 Oct 29;15:172. PubMed PMID: 25352299.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The incremental treatment of ESRD: a low-protein diet combined with weekly hemodialysis may be beneficial for selected patients. AU - Caria,Stefania, AU - Cupisti,Adamasco, AU - Sau,Giovanna, AU - Bolasco,Piergiorgio, Y1 - 2014/10/29/ PY - 2014/06/29/received PY - 2014/10/15/accepted PY - 2014/10/30/entrez PY - 2014/10/30/pubmed PY - 2015/6/6/medline SP - 172 EP - 172 JF - BMC nephrology JO - BMC Nephrol VL - 15 N2 - 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. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/25352299/The_incremental_treatment_of_ESRD:_a_low_protein_diet_combined_with_weekly_hemodialysis_may_be_beneficial_for_selected_patients_ L2 - https://www.biomedcentral.com/1471-2369/15/172 DB - PRIME DP - Unbound Medicine ER -