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Incremental Hemodialysis: How I Do It

Thomas A Golper1

  • 1Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee. thomas.golper@vanderbilt.edu.

Seminars in Dialysis
|August 26, 2016
PubMed

Insights

Incremental hemodialysis (incrHD) is an underutilized approach for end-stage renal disease (ESRD) management. This method, dependent on residual kidney function, is more feasible with home hemodialysis (HD) due to fewer regulatory hurdles and greater patient involvement.

Area of Science:

  • Nephrology
  • Renal Replacement Therapy
  • Dialysis Techniques

Background:

  • Incremental hemodialysis (incrHD) is not widely adopted or understood.
  • US governmental regulations present challenges for incrHD practice in traditional in-center settings.
  • incrHD efficacy is closely linked to residual kidney function (RKF) and personalized end-stage renal disease (ESRD) management goals.

Purpose of the Study:

  • To elucidate the practice strategies and approaches for implementing incremental hemodialysis (incrHD).
  • To highlight the advantages of home hemodialysis (HD) for facilitating an incremental approach.
  • To share practical insights from extensive experience with incremental dialysis.

Main Methods:

  • Discussion of practice strategies for incremental hemodialysis (incrHD).
  • Emphasis on the critical role of assessing and adjusting dialysis based on residual kidney function (RKF).
  • Comparison of facilitators for incrHD in home HD versus in-center HD settings.

Main Results:

  • Home HD is more conducive to incrHD compared to in-center HD.
  • Factors favoring home HD for incrHD include provider experience, patient/family knowledge, suitable dialysis platforms, and less stringent regulations.
  • Successful implementation of incrHD is achievable with appropriate strategies.

Conclusions:

  • Incremental hemodialysis (incrHD) offers a viable approach to ESRD management, particularly when leveraging residual kidney function (RKF).
  • Home hemodialysis (HD) presents a more favorable environment for incrHD due to regulatory and practical advantages.
  • Sharing successful practice strategies is crucial for broader adoption of incrHD.

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