Journal Pre-proof

Feasibility of Twice-Weekly Hemodialysis During COVID-19

Esteban Siga, MD

PII: S2590-0595(21)00133-3
DOI: https://doi.org/10.1016/j.xkme.2021.06.005
Reference: XKME 319

To appear in: Kidney Medicine

Received Date: 18 March 2021

Accepted Date: 18 June 2021

Please cite this article as: Siga E, Feasibility of Twice-Weekly Hemodialysis During COVID-19, Kidney
Medicine (2021), doi: https://doi.org/10.1016/j.xkme.2021.06.005.

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition
of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of
record. This version will undergo additional copyediting, typesetting and review before it is published
in its final form, but we are providing this version to give early visibility of the article. Please note that,
during the production process, errors may be discovered which could affect the content, and all legal
disclaimers that apply to the journal pertain.

© 2021 Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc.
Feasibility of Twice-Weekly Hemodialysis During COVID-19

To the Editor:

We read with interest the research letter by Clark et.al (1) examining the feasibility

of twice-weekly hemodialysis (HD) during the COVID-19 pandemic. Using a stepwise

approach, only 4% of the patients fulfilled their criteria for twice-weekly HD. Therefore,

they concur that twice-weekly HD should be implemented only as a last resort (2).

In contrast, our real-world experience suggests that twice-weekly HD is a valid

of
option for a higher percentage of patients in this health crisis. In March 2020, patients with

ro
a baseline UFR < 8.5 ml/kg/h were switched from three to two sessions per week at our
-p
dialysis clinic. This group comprised 16 out of 48 (33%) patients, and we compared them
re
to 32 patients with a higher UFR who dialyzed three times a week. This prospective six-
lP

month observational study was recently published in Hemodialysis International (3). All
na

but two of the twice-weekly HD patients showed residual diuresis: 1130 ( 95% CI 707–

1554) ml/day. Baseline potassium was 4.4 (4.3–4.5) mEq.Ltr and did not change
ur

throughout the study. Notably, despite being older and having a higher baseline
Jo

erythropoietin resistance index than the 3 times weekly patients, nutrition surrogates and

anemia variables did not show any major changes in the twice-weekly patients. None of

the twice-weekly patients required hospitalization or emergency dialysis.

We acknowledge that our criteria were more relaxed than those of Clark et al (1).

Nevertheless, our data support the notion that selected patients could be safely transferred

to a twice-weekly schedule in times of dialysis unit stress (4).

Esteban Siga, MD

Buenos Aires, Argentina

Article Information
Author’s Affiliation: Centro de Dialsis Madariaga, 7163, Gral Madariaga, Buenos Aires,

Argentina

Financial Disclosure: The author declares that he has no relevant financial interests.

Peer Review: Received April 18, 2021. Accepted April 25, 2021 after editorial review by

the Editor-in-Chief.

REFERENCES

of
1. Clark DA, West KA, Tennankore KK. Feasibility of twice-weekly hemodialysis:

ro
contingency planning for COVID-19. Kidney Med 2021; 3 (2): 314-316
-p
2. Mehrotra R. Counterpoint: twice-weekly hemodialysis should be an approach of last
re
resort even in times of dialysis unit stress. J Am Soc Nephrol. 2020;31:1143–4.
lP

3. Siga E, Elso W, Gil M, Basile H, Benegas M, Ibalo N. Reduced frequency hemodialysis

na

in times of COVID-19: A prospective study in prevalent patients; Hemodialysis

International; DOI 10.1111/hdi. 12915

ur

4. Meyer TW, Hostetter TH, Watnick S. Twice-weekly hemodialysis is an option for many
Jo

patients in times of dialysis unit stress. J Am Soc Nephrol. 2020;31:114–1142.

Clark et al did not respond.