The risk for death is comparable between incremental and conventional hemodialysis in patients with sufficient residual kidney function, investigators report.

Emma Caton, MSc, of the University of Hertfordshire in the United Kingdom, and colleagues performed a systematic review of 22 cohort studies, 2 randomized controlled trials (RCTs), 1 non-randomized controlled trial, and 1 pre-post study involving 101,476 adults receiving hemodialysis. Included studies had a low to moderate risk of bias.

In a meta-analysis of 18 studies, mortality risk did not differ significantly between groups receiving incremental hemodialysis (1-2 sessions per week) and conventional hemodialysis (at least 3 sessions per week), the investigators reported in Nephrology Dialysis Transplantation.

Continue Reading

Clinical circumstances guided the decision to initiate incremental hemodialysis in 18 studies, whereas socioeconomic pressures forced the decision in 8 studies. Death risk was nonetheless comparable after sensitivity analyses excluding patients receiving incremental hemodialysis due to factors such as lack of income, insurance, or proximity to a dialysis center.

According to data from the 2 RCTs, incremental hemodialysis also is significantly associated with a 69% reduced risk of hospitalization compared with conventional hemodialysis, the investigators reported.

Too few studies assessed vascular access complications, fluid overload, hyperkalemia, acidosis, loss of residual kidney function, symptom scores, and quality of life to make definitive conclusions. Four studies estimated the costs of both regimens and suggested that incremental hemodialysis may be cost-saving.

According to Caton’s team, “the findings from this review lend support to the safety of incremental [hemodialysis] as a treatment for ESKD and highlight the potential for this method to be implemented as an alternative to standard care in patients with sufficient [residual kidney function].”

Additional randomized controlled trials are still needed to determine the safety and efficacy of incremental vs conventional hemodialysis.


Caton E, Sharma S, Vilar E, Farrington K. Impact of incremental initiation of haemodialysis on mortality: a systematic review and meta-analysis. Nephrol Dial Transplant. Published online September 20, 2022. doi:10.1093/ndt/gfac274