Purpose of review: There are clinical, physiological, financial, and practical reasons to perform incremental hemodialysis in selected patients, incident to end-stage renal disease. Recent papers inform us further, especially in the large database studies.
Recent findings: Small studies suggested, then a larger study corroborated, that incremental hemodialysis was associated with preservation of residual kidney function whenever compared with conventional hemodialysis. The well tolerated nutritional status of incremental hemodialysis was questioned in a small study but a larger study was more reassuring. The mortality rate of patients undergoing incremental hemodialysis is similar to that in conventional hemodialysis, but only if the comorbidity burden is low.
Summary: Incremental hemodialysis in incident patients can be performed safely, and probably is associated with preserved residual kidney function and a similar mortality rate to convention initiation of hemodialysis. Patients must be prudently selected and managed for this approach to the initiation of dialysis.
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