Efficacy and Safety of Incremental Hemodialysis: A Systematic Review and Meta-Analysis

Hemodialysis, the most commonly employed renal replacement therapy in end-stage kidney disease, prescriptions have long been standardized as thrice-weekly at full-dose; however, HD implementation is not without major complications. Incremental HD modalities are developed to face such one-size-fits-all approach with hopes for better preservation of residual kidney function, better quality of life and patient compliance, lower complication rates, and improvements in morbidity and mortality. A comprehensive literature search was conducted through PubMed, Scopus, the Cochrane Library, Web of Science, and Ovid MEDLINE to identify relevant clinical studies on the efficacy and safety of incremental HD modalities over standard of care HD approach. We have included a total of 35 clinical studies in our final meta-analysis. Our analysis has revealed that incremental HD approach was not associated with statistically significant improvement in all-cause mortality, hospitalization rates, cardiovascular events, intradialytic hypotension or quality of life including mental, and physical components compared to standardized HD approach. Incremental hemodialysis was associated with better preservation of residual kidney function and lower rates of vascular access complications. Incremental hemodialysis was associated with non-inferior clinical outcomes, better preservation of residual kidney function, and fewer vascular access complications than standard thrice-weekly hemodialysis. Larger prospective studies with longer follow-up are needed to support its widespread clinical use.