Incremental and infrequent hemodialysis: a new paradigm for both dialysis initiation and conservative management

Novel conservative management of chronic kidney disease via dialysis-free interventions

“…population may allow some patients to gradually transition to dialysis using an incremental approach (i.e., once or twice-weekly hemodialysis) [32,33]. Indeed, presence of residual kidney function and urine output has been associated with better healthrelated quality of life in dialysis patients, likely because of greater dietary liberalization, improved solute clearance (i.e., thus avoiding the development of uremic symptoms, and better fluid balance (i.e., averting large interdialytic weight gains, high ultrafiltration rates, and subsequent intradialytic hypotension and leg cramping) [32][33][34][35][36][37].…”

Precision Medicine in the Transition to Dialysis and Personalized Renal Replacement Therapy

“…16,23,25À30 Given these numerous benefits, incident ESKD patients' residual kidney function should be measured at the time of transition to dialysis, and reassessed frequently over time. 6,7,21,31 Although oftentimes overlooked as a determinant of an individual's dialysis prescription, there is now increasing interest in alternative dialysis treatment strategies, such as an incremental dialysis approach, as a means to preserve existing residual kidney function.…”

“…Given prior rigorous research studies showing that incremental hemodialysis was associated with higher mortality risk among patients with minimal residual kidney function and higher comorbidity burden, the frequency of hemodialysis must be escalated promptly among patients on an incremental schedule who experience change in these characteristics. 6,7,31 Indeed, in a report documenting the experiences with 13 ambulatory incident hemodialysis patients enrolled in the University of California Irvine's Incremental Hemodialysis Program, five patients maintained a twiceweekly hemodialysis schedule whereas eight patients transitioned to a 3 times/week schedule over a 24-month period. 48 In addition, frequent hemodialysis also may benefit long-term survival among prevalent hemodialysis patients without residual kidney function.…”