BackgroundMost people who make the transition to renal replacement therapy (RRT) are treated with a fixed dose thrice-weekly hemodialysis réegimen, without considering their residual kidney function (RKF). Recent papers inform us that incremental hemodialysis is associated with preservation of RKF, whenever compared with conventional hemodialysis. The objective of the present controlled randomized trial (RCT) is to determine if start HD with one sessions per week (1-Wk/HD), it is associated with better patient survival and other safety parameters.Methods/designIHDIP is a multicenter RCT experimental open trial. It is randomized in a 1:1 ratio and controlled through usual clinical practice, with a low intervention level and non-commercial. It includes 152 incident patients older than 18 years, with a RRF of ≥4 ml/min/1.73 m2, measured by renal clearance of urea (KrU). The intervention group includes 76 patients who will start with incremental HD (1-Wk/HD). The control group includes 76 patients who will start with thrice-weekly hemodialysis régimen. The primary outcome is assessing the survival rate, while the secondary outcomes are the morbidity rate, the clinical parameters, the quality of life and the efficiency.DiscussionThis study will enable to know the number of sessions a patient should receive when starting HD, depending on his RRF. The potentially important clinical and financial implications of incremental hemodialysis warrant this RCT.Trial registrationU.S. National Institutes of Health, ClinicalTrials.gov. Number: NCT03239808, completed 13/04/2017. Sponsor: Foundation for Training and Research of Health Professionals of Extremadura.Electronic supplementary materialThe online version of this article (10.1186/s12882-018-1189-6) contains supplementary material, which is available to authorized users.

In 48 patients on maintenance haemodialysis (HD), serum ferritin (SF) levels were measured and compared with ‘haemochromatosis alleles’, (HA), HLA A3, B7 and B14. A positive correlation was found between high SF levels and the presence of HA. When patients who had received 10 or fewer blood transfusions were studied, it was observed that this correlation did not exist, but it was evident, however, in patients who had received more than 10 blood transfusions. After 14 months in which blood transfusions were restricted, no significant difference in SF was observed between HA carriers and the rest. Our findings suggest that repeated blood transfusions can cause high SF in HD patients, especially in those with HLA A3, B7 or B14 antigens. Among our patients, restriction of blood transfusions seems sufficient to decrease high SF levels.

In order to examine the effect of different dialysates on hemodialysis-induced hypoxemia, 6 stable patients with chronic pulmonary disease (CPD) were compared with 8 control subjets using, alternately, acetate and bicarbonate in the dialysate. These patients were also studied during acetate dialysis and 2 liters/min of nasally administered oxygen. In the control group the presence of hypoxemia with acetate and its absence with bicarbonate suggests that the major mechanism responsible for hypoxemia is hypoventilation. In CPD patients the higher hypoxemia with acetate which bicarbonate analysis did not prevent suggests that a superimposed mechanism may be an important factor in hypoxia aggravation. In these patients hypoxemia can be prevented easily by increasing the inspired oxygen concentration.

Although polyethersulphone HD decreased the interaction of MC with the endothelium in short-term experiments, both membranes were comparable in the long-term.

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