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Incremental Hemodialysis: What We Know so Far.
Vivek Soi1,2, Mark D Faber1,2, Ritika Paul1
1Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA.
Summary
Incremental hemodialysis offers a gradual transition for chronic kidney disease patients, potentially preserving kidney function and improving quality of life. This patient-centered approach requires further research for wider adoption.
Area of Science:
- Nephrology
- Renal Replacement Therapy
Background:
- Standard hemodialysis prescription is often thrice-weekly, based on historical data from prevalent patients.
- Progressive chronic kidney disease necessitates a transition to kidney replacement therapy.
Purpose of the Study:
- To explore the concept and benefits of incremental hemodialysis.
- To evaluate the feasibility and potential advantages of a less frequent dialysis approach.
Main Methods:
- Review of retrospective and registry data supporting incremental hemodialysis.
- Analysis of pilot studies demonstrating implementation feasibility.
- Consideration of residual kidney function and adjuvant therapies.
Main Results:
- Incremental hemodialysis may preserve residual kidney function and enhance patient quality of life.
- Optimal candidacy is suggested by urea clearances >3 mL/min and urine volumes >500 mL/day.
- Barriers include patient acceptance, adherence, and provider workflow adjustments.
Conclusions:
- Incremental hemodialysis presents a patient-centered alternative to traditional thrice-weekly sessions.
- Further large-scale randomized controlled trials are necessary to confirm safety and efficacy.
- Wider acceptance hinges on robust evidence and adaptation of current treatment paradigms.
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