Incremental dialysis in ESRD: systematic review and meta-analysis

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Dialysis Modalities

Background:

• Limited evidence exists on the benefits of incremental dialysis compared to full-dose dialysis.
• Incremental dialysis may preserve residual renal function (RKF) and improve survival.
• The study aimed to compare mortality and RKF loss in incremental versus full-dose dialysis.

Purpose of the Study:

• To compare all-cause mortality between incremental and full-dose dialysis.
• To evaluate residual kidney function (RKF) loss in patients undergoing incremental dialysis.
• To determine the time to progression to full-dose dialysis in incremental hemodialysis (IHD) and incremental peritoneal dialysis (IPD).

Main Methods:

• Systematic review and meta-analysis of adult End-Stage Renal Disease (ESRD) cohort studies.
• Inclusion of studies from PubMed and Web of Science databases.
• Defined IPD as <3 daily dwells (CAPD) or <5 sessions/week (APD); IHD as <3 HD sessions/week.

Main Results:

• Analyzed 22 studies with 75,292 participants; 15 in HD and 7 in PD.
• Incremental dialysis showed lower mean RKF loss (-0.58 ml/min/month) compared to full-dose dialysis (P=0.007).
• Time to full-dose dialysis was extended by approximately 12.1 months, with no significant difference between IHD and IPD.

Conclusions:

• Incremental dialysis effectively preserves RKF, delaying the need for full-dose dialysis by about one year.
• No increased mortality risk was observed with incremental dialysis compared to full-dose dialysis.
• Larger, well-designed studies are required to validate these findings.