Incremental hemodialysis
Keywords:
incremental dialysis, residual renal function, start of dialysis therapyAbstract
Over the past 60 years hemodialysis has been developed and refined as the main life-sustaining therapy for patients with end-stage renal disease. A particularly critical period in the life of patients with chronic kidney disease is the time of transition to the start of dialysis treatment. Thrice weekly hemodialysis regimens have become the standard default prescription worldwide. Incremental hemodialysis is a strategy, personalized approach to initiation of dialysis therapy in which the frequency and duration of dialysis sessions are adjusted based on residual renal function. Interest in this idea has been renewed in recent years, with some recent studies showing that gradual initiation of dialysis treatment may have significant benefits, both for patients and in reducing the burden on healthcare resources. The decision when to start chroniodialysis treatment is based on overall clinical assessment or a decline in estimated glomerular filtration rate. The concept can be extended to a progressive increase in dialysis dose according to the gradual decrease in residual renal function, with a view to achieving satisfactory metabolic control. This stepwise approach is the basis of incremental dialysis, which is increasingly seen as a patient-friendly way to allow a smooth transition from pre-dialysis care to full-scale renal replacement therapy, reducing the so-called “dialysis shock.”
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