Impact of Incremental versus Conventional Hemodialysis Initiation on Residual Kidney Function: A Systematic Review

Abstract

Introduction: The optimal timing and frequency of hemodialysis (HD) initiation in patients with ESRD is debated. An incremental approach (e.g., starting with twice-weekly HD) has been proposed to better preserve residual kidney function (RKF). This review compares incremental versus conventional (thrice-weekly) HD initiation.

Methods: A search for RCTs and prospective cohort studies was performed. We included studies that compared an incremental HD initiation strategy to a conventional strategy. The primary outcome was the rate of decline of RKF.

Results: The review of eight studies showed that an incremental HD initiation strategy was associated with a significantly slower rate of RKF decline compared to a conventional thrice-weekly start. There were no significant differences in mortality or hospitalization rates between the two approaches, provided patients were carefully selected and monitored.

Discussion: Preserving residual kidney function is associated with better survival and quality of life. An incremental start to hemodialysis is a viable strategy to achieve this goal in appropriate patients with significant RKF.

Conclusion: An incremental hemodialysis initiation strategy is effective in preserving residual kidney function compared to a conventional approach.