Initiation of Once-A-Week Hemodialysis / 日本農村医学会雑誌

ABSTRACT

Patients with chronic renal failure (CRF) have a great psychological burden before they start hemodialysis and when the treatment begins. We initiated once-a-week hemodialysis program, designed to reduce the psychological burden as well as to keep the residual renal function. A total of 13 CRF patients with an adequate urine volume participated in this program. Nutritional counseling was done in all the patients. They were on hemodialysis for five hours at a time. The blood flow rate of more than 200ml/min was secured. Dialyzers with the largest filtering membrane area possible were used, the physique of the patients taken into due consideration. The weekly hemodialysis treatment was continued, so long as the levels of serum urea nitrogen, serum creatinine and body weight gain were lower than 100 mg/dl, 13.0mg/dl, and 3.0kg/week, respectively. Pre-dialysis urine volume and creatinine clearance were 1, 370±160ml/ day and 4.7±0.4ml/min, respectively. The hemodialysis treatment continued for 25±5 times. There were no significant correlations between the duration and pre-dialysis levels of urine volume, creatinine clearance, serum urea nitrogen, serum creatinine, hematocrit, arterial blood pH and HCO<SUB>3</SUB><SUP>-</SUP>. Hemodialysis were discontinued when there were increases in body weight (7 patients), the increase in solutes (3 patients), and both (3 patients). The average monthly medical expenses involved in once-a-week hemodialysis was 55.1% of those entailed by hemodialysis treatment three times a week. Once-a-week hemodialysis is suitable for the conditions 1. Patients have an ad quate urine volume and no severe edema. 2. Serum urea nitrogen and creatinine levels are not extremely high. 3. Patients fully comply with their dietitian's advice. 4. Shunt blood fl ow is kept enough. Provided these conditions are met, our study suggested, once-aweek hemodialysis should be considered as one of the treatment options, because it was proved effective in reducting CRF patients psychological burden, maintaining residual renal function, and cutting medical costs.