Abstract: TH-PO262
Incremental Hemodialysis (IHD) Is a Cost-Effective and Patient-Centered Kidney Replacement Therapy
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
Author
- Takahashi, Toshimasa, Bosei Shinjyuku-Minamiguchi Clinic, Tokyo, Japan
Background
Hemodialysis (HD) in Japan is the highest quality of Renal Replacement Therapy (RRT) in the world, but its cost is increasing continuously. The conventional thrice-weekly regimen is a common way to introduce HD but not Incremental hemodialysis (IHD) in Japan. When HD patients’ conditions are sufficiently managed by once-/twice-weekly HD with good adherence to their diet, its cost-reduction effect can be expected.
Methods
We selected 62 CKDG5 outpatients with good adherence to diet, we initiated IHD considered residual renal function individually and careful follow-ups from 2013 to 2023. The average age was 62 (21 to 90), and 74% was men. Their causes of ESRD include chronic glomerulonephritis (35%), diabetic kidney disease (34%), nephrosclerosis (21%), and others (10%; polycystic kidney disease, chronic interstitial nephritis, Hypoplastic kidney).
Results
4.3, Ccr was 5.9mL/min, and mean urine volume (UV) was 1586 mL/day. 24 patients were treated with twice-weekly HD; their mean eGFR was 4.4, Ccr was 4.8mL/min, and mean UV was 1273 mL/day. We determined the number of dialysis cycles, taking into account the patient's background, underlying disease, and compliance before the initiation of dialysis, and individually studied the dialysis conditions based on laboratory data and weight gain.
A significant difference was observed in UV between once-weekly and twice-weekly HD (The data were analyzed for statistical student’s t-test. Difference was assessed with a two-sided test with a level of 0.05.) and no significant difference in eGFR and Ccr. The overall 1-year survival rate of IHD was 98.4%, and the 5-year survival rate was 81.2%.
In these 62 patients, the total number of once-weekly HD was 357M (8.7M/person), the total number of twice-weekly HD was 1234M (23.7M/person), and the cost reduction during this period was 41.8% compared with that all patients did thrice-weekly HD.
Limitation: The cost of dialysis was based on the Japanese medical insurance system in 2023. Selection bias cannot be avoided.
Conclusion
IHD is a patient centered RRT that provides cost-effective and sustainable treatment for ESRD patients.