Phased Introduction of Haemodialysis in Patients with Kidney Failure: A Mixed-Methods Feasibility Study

Background: Introducing haemodialysis (HD) treatment in a phased manner, with lower treatment times at the outset combined with pre-defined increments in treatment over a period of several weeks, reduces the early burden of treatment in patients with kidney failure and may help improve early outcomes. We have evaluated the feasibility of a novel transitional HD regime using a mixed-methods approach. Method: A single-centre cohort design was adopted, where participants were enrolled prospectively into an interventional arm and matched with historical controls. This paper reports on the feasibility of recruitment and retention in the prospective arm. People with kidney failure, starting HD treatment in out-patient settings, were recruited. They started HD on a transitional regime, with four pre-specified incremental steps (Phases 1 to 4), which aimed to establish participants on long-term 3× weekly treatments over 14 weeks. Participants' experiences of starting HD in a phased manner were analysed using semi-structured interviews. Results: We screened 127 people over 18 months: eligible: 54 (43%); enrolled: 25 (46% of eligible). Fifteen started HD within the study timeframe; 14 were retained for 6 months. In 13 participants, the regime was altered (mostly during Phase 2) for clinical or scheduling reasons. Semi-structured interviews (n = 11) found participants overwhelmingly liked the phased HD introduction as an aid to becoming normalised to dialysis routines. Alterations to treatment were not associated with adverse experiences. Participants would highly recommend starting dialysis in this stepped and phased manner. Conclusions: It is feasible to enrol and retain participants in the proposed program of phased start of HD. The regime may be implemented flexibly in future trials. Starting dialysis on a less-than-three-times weekly basis was well received by participants. Trial Registration: Clinicaltrials.gov registration NCT04268264 (registered: 11 February 2020).