A NEW study suggests that beginning haemodialysis with a less intensive, “incremental” approach may help preserve patients’ remaining kidney function without increasing the risk of death or major complications.
Dialysis Initiation Strategies and Residual Kidney Function
Chronic kidney disease (CKD) affects millions worldwide, and haemodialysis (HD) is the most commonly used treatment for patients with kidney failure. Traditionally, patients start on a standard schedule of three dialysis sessions per week, each lasting at least four hours. However, some experts have questioned whether this approach may accelerate the loss of residual kidney function (RKF), the small amount of natural kidney function many patients still have when dialysis begins.
To explore this, researchers conducted a retrospective case-control study involving 80 patients with stage 5 CKD who started dialysis between January 2021 and January 2023. Half of the patients began on incremental HD, defined as either two sessions per week lasting four hours or three shorter weekly sessions. The remaining patients followed the standard thrice-weekly dialysis schedule. The two groups were carefully matched for age, sex, underlying kidney disease, comorbidities, and baseline laboratory results.
The patients had a mean age of nearly 64 years, and half were male. Diabetes and hypertension were the most common causes of kidney failure. Over a two-year follow-up period, a small proportion of patients received kidney transplants (3.8%), died (6.2%), or recovered kidney function (2.5%).
The results showed a clear difference in kidney function preservation. Nearly half (45%) of patients in the incremental HD group retained residual kidney function, while none of the patients on standard HD did. Those on incremental dialysis also experienced fewer infections, particularly bloodstream infections, and maintained kidney function for a longer period. In addition, patients receiving incremental HD reported better quality of life.
Importantly, the study found no significant differences between the two groups in terms of cardiovascular events, mortality, or transplantation rates. Factors associated with better RKF preservation included use of incremental HD, higher blood albumin levels, and the absence of bloodstream infections.
Findings Support Gradual Dialysis Starts, but More Research Needed
The authors conclude that starting dialysis gradually may offer meaningful benefits for selected patients, helping preserve kidney function and improve daily life without compromising safety. They emphasise, however, that larger prospective clinical trials are still needed to confirm these findings and guide wider adoption of incremental, patient-centred dialysis strategies.
Reference
Barbosa BVS et al. Incremental vs. standard hemodialysis for preserving residual kidney function: a case-control study. BMC Nephrol.2025;26:695
