Researchers from the UK conducted a feasibility study to determine whether incremental initiation of hemodialysis leads to better maintenance of renal function than conventional treatment. Although they found no apparent benefit, the incremental dialysis regimen was found to be safe and cost effective.
In the trial, 55 patients (urea clearance ≥ 3 ml/min/1.73 m2) from four centers randomized to begin hemodialysis with either an incremental (n = 29) or a conventional (n = 26) dialysis schedule for 12 months. The incremental schedule consisted of two sessions per week, with the dialysis dose built up as residual renal function declined, such that the total (dialysis+renal) standard Kt/V remained above 2. The conventional dialysis treatment consisted of three sessions of 3.5-4 hours per week with a minimum standard Kt/V of 2. Subsequently, various parameters for feasibility, the rate of renal function decline, healthcare costs and patient-reported outcome measures (PROMs) were measured.
After 12 months of follow-up, 21 of the patients in the incremental group were still in the study, compared to 12 in the conventional group. There appeared to be no differences between the groups in the decline in renal function and in mortality (three deaths in each group). Blood pressure, amount of extracellular fluid and PROMs were also comparable.
In the group with the incremental dialysis schedule, fewer serious adverse events occurred (incidence rate ratio 0.47; 95% CI 0.27-0.81) and the serum bicarbonate concentration and treatment costs were lower than with a standard dialysis schedule. All in all, it could be concluded that the incremental treatment is safe and cost-effective and that a larger follow-up study is justifiable.
Bron:
Vilar E, Kaja Kamal RM, Fotheringham J, et al. A multicenter feasibility randomized controlled trial to assess the impact of incremental versus conventional initiation of hemodialysis on residual kidney function. Kidney Int 2022;101:615-25.