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Updated: Mar 3, 2026
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Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
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Incremental Hemodialysis Practices and Impact on Survival: Systematic Review and Meta-Analysis
Adil M Hazara1,2, Abdullah Abdullah3, Victoria Allgar4
1Department of Renal Medicine, York and Scarborough Teaching Hospitals NHS Foundation Trust, United Kingdom.
Kidney Medicine
|March 2, 2026
Summary
Incremental hemodialysis (HD) may reduce treatment burden for kidney failure patients. This systematic review found incremental HD is at least as safe as conventional HD, with equivalent survival rates in larger studies.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Public Health
Background:
- Starting hemodialysis (HD) incrementally can potentially lessen treatment burden for patients with established kidney failure.
- Variations in incremental HD practices globally and their impact on mortality require systematic investigation.
Purpose of the Study:
- To describe worldwide variations in incremental HD practices.
- To evaluate the impact of incremental HD on patient mortality.
Main Methods:
- A systematic review of observational and interventional studies was conducted.
- Searches included Medline and Academic Search Premier from inception to July 20, 2020.
- Studies compared incremental (twice-weekly) HD with conventional (thrice-weekly) HD, focusing on mortality outcomes.
Main Results:
- Fourteen studies (91,928 participants) were included, noting significant practice variations in incremental HD.
- Meta-analysis showed no significant difference in mortality (HR 0.97; 95% CI 0.76-1.19).
- Centers screening for residual kidney function and setting clear goals showed better outcomes with incremental HD.
Conclusions:
- Significant variability exists in incremental HD implementation, necessitating context-specific evaluation.
- The optimal method for incremental HD remains debated.
- Current evidence suggests incremental HD is non-inferior to conventional HD regarding survival.
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