Dr SUCHETA PERERA1, LEANNE MILLS1, A/Prof PETER MOUNT1
1Department of Nephrology Austin Health
Aim: To describe outcomes of patients being treated with Incremental Haemodialysis (IHD) at Austin Health
Background: IHD involves adjusting the haemodialysis (HD) prescription according to measured residual kidney function. IHD is not widely practiced in Australia and the outcomes are not well characterised.
Methods: A retrospective and prospective audit was conducted from May 2018 to December 2021 comparing IHD to standard haemodialysis (SHD) or peritoneal dialysis (PD). Clinical criteria for IHD included measured residual urea clearance of greater than 2 ml/min, and capacity to comply with regular timed urine collections and adjustments to HD prescription.
Results: The audit included 95 patients with 31, 32 and 32 in the IHD, SHD and PD groups respectively. The median ages were 69 (IHD), 77 (SHD) and 68 (PD) years and the most common cause of kidney failure was diabetes. There were no significant differences in gender, ethnicity, cardiovascular disease, cancer and smoking status between groups. Patient survival at 3-years was IHD 93%, SHD 54%, PD 86% (NS, P = 0.066, log-rank). Median technique survival for IHD, defined as remaining on less or equal to 10.5 hours of HD per week was 8 months, lower than both SHD (31 months) and PD (19 months) (P = 0.0007, log-rank). Patients doing IHD received a median 9 hours dialysis per week, compared to 12 hours in the SHD group (p<0.0001). However, mean total urea clearance (dialysis plus renal), measured as weekly Std Kt/V, was greater in the IHD group (3.4) than the SHD (2.4) and PD (2.3) groups (p<0.0001).
Conclusion: In selected patients, IHD enabled less dialysis for a median of 8-months, with reassuring safety outcomes in terms of patient survival.
Biography:
Sucheta Perera is a Basic Physician Trainee in Victoria looking to pursue Nephrology Advanced Training. She has particular interests in haemodialysis as transplant medicine.