Effect of Incremental Hemodialysis on Residual Kidney Function and Other Laboratory Parameters in End Stage Renal Disease Patients Starting Dialysis
Authors: EL-Sharkawy Magdy Mohamed , Abdel-aziz Haitham Ezzat , Hassan Mohamed Saeed , Khedr Lina Essam , Abuelanin Lotfy Mohamed Lotfy 
Published: August 2023

Abstract

Background
Residual kidney function (RKF) in patients with end-stage renal disease plays a critical role in dialysis adequacy, quality of life, and survival by maintaining fluid and metabolic homeostasis, mitigating mineral abnormalities, optimizing uremic toxin clearance, and sustaining higher production of endogenous vitamin D and erythropoietin. Endogenous clearance conferred by RKF is associated with greater survival than dialysis clearance per se, and at a certain RKF level, higher dialysis dose may not influence clinical outcomes in both peritoneal and hemodialysis patients. Furthermore, randomized controlled trials (RCTs) have shown inconsistent results in terms of clinical benefit of higher dialysis dose or frequency, and they may accelerate RKF decline.

Aim of the Work
To detect the effect of twice – weekly HD on patients starting dialysis regarding laboratory parameters and preservation of kidney function.

Patients and Methods
This prospective cohort study included 30 patients from multiple convienant dialysis units in 10th of Ramadan and Mushtoul Elsouq city to initiate twice-weekly hemodialysis, the patient should meet the first (urine output &gt;600 ml/day) and the last criteria (KRU &gt; 3 ml/minute/1.73 m2)d, plus most (five out of nine). Patients were examined for these criteria every month for 3 months. Regarding baseline data, this study patients had a mean age of 49.6 ± 8.7 years old, with a range from 32 to 65 years old, with male predominance (70 %), the mean weight of the studied patients was 79.9± 10.31 kg, with a range from 55 to 105 Kg, and their height ranged from 160 to 185 cm, the main etiology of ESRD was hypertension in 46.7 % of the studied patients, followed by DM in 30% then DM with hypertension in 16.7%.

Results
The study shows that there's highly significant increase in serum PTH and bicarbonate all over the study period, there's significant increase in serum phosphorus level, there's highly significant increase in serum albumin, there's highly significant increase in Hemoglobin all over the study period. There's highly significant increase in serum calcium, there's highly significant increase in Serum Potassium, there's highly significant decrease in Serum Creatinine, Urea before and urea after dialysis all over the study period. This study showed that there's highly significant increase in renal KT/V, there's highly significant increase in RKF, there's highly significant decrease in urine Urea and there's no statistically change in dry weight of patients all over the study.

Conclusion
In conclusion, in our selected cohort of incident hemodialysis patients with measured RKF, the incremental hemodialysis regimen that starts with twice-weekly schedule upon transition to dialysis is associated with greater preservation of the RKF in the first 3 months and may be safely implemented among incident hemodialysis patients with substantial RKF.