Mastrangelo F, Alfonso L, Napoli M, Russo F, De Blasi V
Long-term results of a dialytic schedule with increased frequency
of HD sessions
17th Annual CAPD Conference
Perit Dial Int Suppl 1
(Feb) 17:S80 1997
In this abstract, some extremely high survivals are reported for patients
following a 4x/week or every other day dialysis schedule, where relatively
short dialysis session lengths (150-180 min) were used. Session Kt/V was
in the range of 1.1, apparently, but no data are given. It is said that
31% of patients were "high risk", although mean age at onset of dialytic
therapy was 46 years. This more intensive dialysis schedule has apparently
been used since 1978. Survivals were quite high, 970% at 1 year, 89% at 2
years, 79% at 3 years, and 56% at 10 years.
Interestingly, all or most of these patients had AV fistulae, with
survivals of 100% at 1 year, 99% at 3 years, and 93% at 6 years.
Comment: I don't think that the actual amount of dialysis being
given greatly exceeds that given many patients in the United States, nor
do I believe that use of an alternate day schedule was responsible for this
program's astoudingly high survival rates. Cardiovascular disease caused
only 11% of deaths, and sepsis only 5% of deaths. I am very impressed with
the high AV fistula survival. I believe the low sepsis incidence may have
been due to the prevalent and very successful use of fistulae. The low
cardiovascular death rate may be due to patient selection and to the
relatively young age of the patients involved. It is quite possible,
however, that using a qod dialysis schedule or 4x/week schedule also
affords significantly reduced mortality. (John T. Daugirdas, M.D.,
University of Illinois at Chicago)
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17th Annual CAPD Conference
Basic hemodialysis :
Adequacy, prescription, urea kinetics
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