Dialysis Free Protocol for Some End Stage Renal Disease Patients (Khosroshahi Protocol)

Abstract

Background: The number of patients with End Stage Renal Disease (ESRD) is growing annually around the world. Provision of renal replacement therapy in the form of dialysis and transplant is relatively expensive. Recent studies have shown no survival benefit of early initiation of dialysis. Given recent outcome data of the timing of dialysis treatment and the expenses and logistics of hemodialysis procedure have stimulated research on alternative strategies. The aim of this study is to introduce another type of renal replacement therapy for selective patients with advanced chronic kidney disease (CKD).

Methods: In a case series we used a so-called “dialysis free protocol” consisting of a low protein diet, uremic toxin adsorbents, and prebiotics for selective ESRD patients who had dialysis access constraints or did not agree placement of hemodialysis vascular access or peritoneal dialysis catheter.

Findings: clinical and biochemical results of this study showed that these patients were not deteriorating during the study period and Blood Urea Nitrogen (Bun) & serum creatinin levels were not elevated in these months. Participating patients were relatively well throughout the study without signs of florid uremia and without a need for emergent or urgent dialysis.

Conclusion: We conclude that our proposed dialysis free protocol reduces the need for dialysis treatment at least transiently. Whether this protocol can reduce the need for dialysis treatment requires additional studies.

Key words: End Stage Renal Disease, Low Protein Diet, Prebiotics, Activated Charcoal