Before embracing HD3.5 as the preferred prescription, we must rigorously evaluate its domain of adequacy, its effective cost in light of current reimbursement and its influence on patient lifestyles. In 1998, Mastrangelo reported the findings of a program of dialysis targeting reduction of the long interdialytic interval while maintaining conventional-short dialysis time (£ 4 hours) by use of high blood flow rates and efficient dialyzers with bicarbonate dialysate1. Enrollment in this study started in 1978 and by 1993 224 patients had been recruited. Dialysis prescription was alternate daily (7 sessions per two weeks) for smaller patients and 4-times weekly for larger patients. Dialysis session times of less than 180 minutes were prescribed but subsequently were abandoned. Average spKt/V was 1.31. No dietary restrictions were advised. Interdialytic weight gains were in the range 2.6 to 2.9 kg, strongly suggesting that sodium intake was not restricted. Blood pressure was deemed controlled in 85% of patients with only 39% of patients requiring antihypertensive medications. Anemia was reasonably managed (average hematocrit 31%) without erythropoietin. Nutrition (nPCR and serum albumin) was adequate. Sixty-nine patients (31%) died over a period of 17 years (1978-1994) and probability of survival at 10 years was 60%. Comparing the results for the Lecce program and that for the Tassin patients, incident from 1975–1979 (168 patients) and from 1984-1989 (239 patients), yields the data shown below.
Survival curves replotted for the Lecce patients and two cohorts from the Tassin experience
Click image to enlarge
By this comparison, patient survival in the Lecce program exceeds that in Tassin in the 1985-1989 cohort and is equivalent to that in 1975-1979 cohort. Patients in Tassin dialyzed 24 hours per week and had a long interdialytic interval of 64 hours. Patients in Lecce dialyzed between 10.5 and 12 hours per week but had a long interdialytic interval of only 45 hours.
Domain of adequacy of HD3.5
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Reference:
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Mastrangelo F, Alfonso L, Napoli M, DeBlasi V, Russo F, Patruno P. Dialysis with increased frequency of sessions (Lecce dialysis). Nephrol Dial Transplant 13 (Suppl 6):139-147, 1998