Reduced intensity incremental hemodialysis start does not decrease life expectancy and saves money: results of the RIDDLE study.

backgroundSince 2001, twice-weekly hemodialysis has been the standard method for starting hemodialysis at the Alba Hospital (Piedmont, Italy).

methodsIncident patients who started in-center hemodialysis from January 2001 to December 2016, had sufficient residual kidney function (urine output > 500 ml/day), and survived on hemodialysis > 1 year were selected and followed until death or censoring on December 31, 2019. The endpoints for the whole cohort are survival, duration of twice-weekly hemodialysis, preservation of residual kidney function, and cost savings. Analysis was performed on subgroups with long-term (L: >  = 365 days) or short-term (S: < 365 days) twice-weekly hemodialysis duration, matched for age, sex, year of hemodialysis start, type of vascular access and diabetes.

resultsThe study included 146 patients with a total follow-up of 251,328 patient-days, of which 80,635 on twice-weekly hemodialysis. The median survival was 1793 days, median twice-weekly hemodialysis duration was 417 days, and median residual kidney function duration was 820 days. In the matched comparison, the long-term duration twice-weekly hemodialysis group had lower admissions (18.2 vs 27.7/1000 patient-days) and unscheduled hemodialysis session rates (0.26 vs 0.75/1000 patient-days) and greater median residual kidney function duration (1353 vs 445 days), but similar median survival (1809 vs 1744 days). During twice-weekly hemodialysis, 12,291 hemodialysis sessions were spared, resulting in a cost saving of 1,986,226 Euros, based on current local reimbursement fees.

conclusionsTwice-weekly hemodialysis, under strict clinical surveillance appears to be a safe, feasible, and cost-saving method for initiating hemodialysis in patients with residual kidney function.