Incremental Versus Conventional Hemodialysis for Preservation of Residual Kidney Function in Patients on Regular Hemodialysis

Abstract

Background: Incremental hemodialysis (HD) has several potential advantages for patients, physicians and health care systems. In incident HD patients, conservation of residual kidney function RKF is significant and is correlated with several advantages, including survival of patient, improved quality of life, improved overall nutritional status and less anemia. The aim of this work was to evaluate incremental hemodialysis (twice/week) compared with conventional dialysis (thrice/week) for the conservation of the residual kidneyfunction among patients initiating regular hemodialysis. Aim of work: The primary outcome of the study was an evaluation of incremental hemodialysis (twice/week) compared with conventional dialysis (thrice/week) for the conservation of the residual kidney function among patients initiating regular hemodialysis. Patient and Methods: We assigned 40 patients with chronic kidney disease stage V D who early started hemodialysis into 2 groups: Group 1: 20 patients underwent incremental hemodialysis (twice/week), and Group 2: 20 patients underwent conventional hemodialysis (thrice/week). All patients followed for laboratory findings of (complete blood picture, creatinine, urea, calcium, albumin, phosphorus, parathyroid hormone, alkaline phosphatase, glomerular filtration rate). Also, Kt/v at start and every month was done. Clinical outcome measures included; mortality, cardiovascular outcome, hospital admission and dialysis complications. Results: In the studied population, the mean age was (45.95 ± 2.97) years. Regarding sex 60% were males and 40% were females. Regarding outcome data, (20%) of patients had hypotension, (15%) had hospital admission, while nobody suffered mortality. Comparative study among the two groups showed a substantial decrease in the incidence of hypotension in the incremental group (40 %) relative to the conventional group (10%) (p = 0.03). Conclusion: To conclude, our research investigates the correlation among the frequency of HD treatment and survival of patient. In line with recent literature, our results show that some selected patients with acceptable RKF, sufficient control of interdialytic gaining weight, and low or moderate burden of comorbid disease (CCI < 5) in an incident HD population, an HD incremental approach may be deemed as an appropriate alternative to conventional thrice-weekly HD.