Observational studyBMC nephrology2025
Incremental vs. standard hemodialysis for preserving residual kidney function: a case-control study.
Observational study in BMC nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
purposeChronic kidney disease (CKD) is a global health issue, and hemodialysis (HD) is the most commonly used dialysis method. Incremental HD has been proposed as an alternative, but evidence on its safety and benefits is limited. This study compared residual kidney function (RKF) preservation in patients undergoing incremental versus standard HD, also evaluating quality of life, hospitalizations and mortality.
methodsThis retrospective, longitudinal, observational case-control study included stage 5 CKD patients who started either incremental or standard HD between January 2021 and January 2023. The case group included patients who began incremental HD (2 weekly sessions lasting 4 h or 3 weekly sessions lasting < 3.5 h), and the control group included patients who started standard HD schedule (thrice-weekly, minimum 4-hour sessions). The groups were matched by age, sex, underlying disease, comorbidities, and baseline lab values.
results80 patients were included (50% male; mean age 63.8 ± 11.9 years). Diabetes (32.5%) and hypertension (22.5%) were the main underlying conditions. Over two years, 3.8% had kidney transplants, 6.2% died, and 2.5% recovered kidney function. 45% of incremental HD patients retained RKF; none did in the standard HD schedule group. Incremental group had fewer infections, longer time free from loss of RKF than control group and better quality of life. No differences were found in cardiovascular events, mortality, or transplantation. RKF preservation was associated with incremental HD, higher albumin, and absence of bloodstream infections.
conclusionStarting HD with an incremental may better preserve RKF without compromising survival, while improving quality of life. Further clinical trials are needed to evaluate the safety and effectiveness of incremental HD and support its broader, patient-centered use. CLINICAL TRIAL NUMBER: Not applicable.
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