Kidney Week

Abstract: TH-PO261

Clinical Features of a Multiethnic Cohort of Patients on Twice-Weekly Incremental Hemodialysis

Session Information

• Hemodialysis, Hemodiafiltration, and Frequent Dialysis
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Simon, Lewis, University of California Irvine, Irvine, California, United States

Lewis Simon, MPH

• Tran, Diana, The Lundquist Institute, Torrance, California, United States

Diana Tran, MPH

• Takahashi, Rina, The Lundquist Institute, Torrance, California, United States

Rina Takahashi

• Ismail, Adnan M., The Lundquist Institute, Torrance, California, United States

Adnan M. Ismail, BS

• Sohn, Peter, SoCal Kidney Consultants, Garden Grove, California, United States

Peter Sohn

• Yoon, Ji Hoon, The Lundquist Institute, Torrance, California, United States

Ji Hoon Yoon, MS

• Le, Lisa, The Lundquist Institute, Torrance, California, United States

Lisa Le

• Daza Aguilar, Andrea C., The Lundquist Institute, Torrance, California, United States

Andrea C. Daza Aguilar

• Novoa Vargas, Alejandra, The Lundquist Institute, Torrance, California, United States

Alejandra Novoa Vargas, MPH

• Chang, Yongen, VA Long Beach Healthcare System, Long Beach, California, United States

Yongen Chang, MD, PhD, FASN

• Tong, Lili, VA Long Beach Healthcare System, Long Beach, California, United States

Lili Tong, MD

• Rhee, Connie, The Lundquist Institute, Torrance, California, United States

Connie Rhee, MD, MS

• Kalantar-Zadeh, Kamyar, The Lundquist Institute, Torrance, California, United States

Kamyar Kalantar-Zadeh, MD, DrMed, PhD, MPH, FASN

Background

While current KDOQI guidelines support starting incident ESRD patients with substantial KRU on incremental hemodialysis (HD), many of these patients are started on thrice-weekly HD regardless of KRU. Few studies have examined characteristics of diverse ESRD patients on incremental twice-weekly incident HD patients in the United States. We aimed to characterize a diverse cohort of ESRD patients started on incident HD and explore factors associated with their transition to conventional HD.

Methods

We conducted a case-series of 59 incident incremental HD patients at a local dialysis center, with patients observed from September 2021 to May 2022. Data such as KRU, incremental HD duration, HD schedule and demographics were extracted from EMR. Differences were examined across sex and ethnicity and across two subgroups- those who transitioned from incremental to conventional HD and those who did not.

Results

The cohort was 64% Hispanic and 41% female. Mean age at HD start and transition were 51.9 and 49.6 years, respectively. Thirty-eight (64.4%) patients transitioned to thrice-weekly HD, most often due to volume overload (34%). The most prevalent incremental HD schedules were Monday/Friday (42%) and Tuesday/Saturday (44%). Mean twice-weekly HD duration for transitioners was 47 weeks. Mean baseline and transition KRU were 3.8 and 1.7 mL/min./1.73m², respectively. Non-Hispanic Whites had higher transition rates compared to Asians and Hispanics but these differences were not significant (p=0.12). Among transitioners, males had longer incremental HD duration (p=0.03), and females had higher transition rates by the 52-week mark (p=0.04). Median weeks-to-transition was 24.3 (95% CI: 20.5-30.0) for males and 16.0 (95% CI: 14.7-16.6) for females.

Conclusion

We characterized a diverse cohort of twice-weekly incremental HD patients. Differences in incremental HD duration and incremental-to-conventional HD transition rates across sex and ethnicity were identified. These findings can inform researchers and clinicians regarding disparities in incremental HD effects across diverse ESRD populations. More research is needed to further assess the long-term effects of incremental HD, particularly in underrepresented and underserved ESRD patient populations.