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.
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.
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.
Division Nashville of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Correspondence to Thomas A. Golper, MD, FACP, FASN, S-3303 Medical Center North, Vanderbilt University Medical Center, 21st Avenue South, Nashville, TN 37232, USA. Tel: +1 615 322 5914; fax: +1 615 322 8653; e-mail: firstname.lastname@example.org