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Clin Kidney J. 2015 Jun;8(3):271-7. doi: 10.1093/ckj/sfv021. Epub 2015 Apr 7.

The first year on haemodialysis: a critical transition.

Author information

1
Department of Internal Medicine, Division of Nephrology , Maastricht University Medical Centre , Maastricht , The Netherlands ; NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Internal Medicine , Maastricht UMC+ , Maastricht , The Netherlands.
2
Department of Internal Medicine, Division of Nephrology , Maastricht University Medical Centre , Maastricht , The Netherlands.

Abstract

The first year following the start of haemodialysis (HD) is associated with increased mortality, especially during the first 90-120 days after the start of dialysis. Whereas the start of dialysis has important effects on the internal environment of the patient, there are relatively few studies assessing changes in phenotype and underlying mechanisms during the transition period following pre-dialysis to dialysis care, although more insight into these parameters is of importance in unravelling the causes of this increased early mortality. In this review, changes in cardiovascular, nutritional and inflammatory parameters during the first year of HD, as well as changes in physical and functional performance are discussed. Treatment-related factors that might contribute to these changes include vascular access and pre-dialysis care, dialysate prescription and the insufficient correction of the internal environment by current dialysis techniques. Patient-related factors include the ongoing loss of residual renal function and the progression of comorbid disease. Identifying phenotypic changes and targeting risk patterns might improve outcome during the transition period. Given the scarcity of data on this subject, more research is needed.

KEYWORDS:

arterial stiffness; fluid overload; haemodialysis; pre-dialysis; vascular calcification

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