Comparison between incremental and thrice‐weekly haemodialysis: Systematic review and meta‐analysis

Liu, Yueming; Zou, Wenli; Wu, Juan; Liu, Lin; He, Qiang

doi:10.1111/nep.13252

Cited by 22 publications

(29 citation statements)

References 27 publications

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“…A recent meta-analysis has reported a risk reduction of 20% with incremental dialysis [9]. However, this remains controversial [14], without any available RCT and possible bias by indication when twice-weekly HD is implemented for economic matters or/and in patients younger DOI: 10.1159/000494582 with less comorbidities as reported by Lindenfeld et al [15].…”

Section: Does Twice-weekly Dialysis Reduce Early Mortality Of Incidenmentioning

confidence: 95%

“…Because the short daily Frequent Hemodialysis Network trial has reported a 78% increase of vascular access interventions with 6-weekly short HD sessions compared to standard HD [52], several papers point out a presumed advantage of better or potentially better vascular access longevity with incremental HD, compared to standard HD [9,16,32,53]. Presently there is no evidence that twice-or thrice-weekly needle insertions make a difference in the vascular access longevity.…”

Section: Vascular Accessmentioning

confidence: 99%

“…In the meta-analysis by Liu et al [9], RRF and UO are better preserved with incremental or twice-weekly HD when compared to thrice-weekly HD. As mentioned above, only 16 studies were included in the analysis, and 7 regarding the effect on RRF and/or UO.…”

Section: Is Twice-weekly Dialysis Associated With a Better Preservatimentioning

confidence: 99%

“…The available clinical data are not numerous and recently 16 studies were identified for a meta-analysis [9]. We will focus the debate of twiceweekly HD (incremental) versus standard thrice-weekly HD.…”

Section: Why Challenging An Hd Full Start?mentioning

confidence: 99%

“…In the meta-analysis of 15 studies by Liu et al [9], incremental HD offers a survival advantage compared to standard thrice-weekly (risk ratio at 0.80 [0.73-0.87]). Heterogeneity of these data has been underlined above.…”

Section: Incremental Hd Program and Hard Outcomesmentioning

confidence: 99%

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End-Stage Kidney Patients Require Hemodialysis Therapy Full Start

Chazot

Jean

2018

Blood Purif

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Recently the concept that prescription of chronic hemodialysis (HD) start should be tailored based on residual renal function (RRF) and urine output (UO) has been revived from the past and called infrequent or incremental dialysis. It mainly consists in prescribing 1 or 2 HD sessions per week instead of what has become the standard thrice-weekly HD. It is both surprising and fascinating that almost 60 years after the first end-stage kidney disease patient was treated by Scribner et al. [Trans Am Soc Artif Intern Organs 1960; 6: 114–122], the nephrology community still questions the best way to start HD therapy. This comforting process is the result of pieces of evidence accumulated with time such as that RRF is associated with better outcomes that starting HD therapy favors the loss of RRF and/or UO and also results in a high rate of deaths in the first weeks of HD therapy. Through this review, we support the idea that when the decision to start HD therapy is made, ideally with the full collaboration of the patient, it is necessary to be efficient to alleviate uremic symptoms, to correct the fluid overload and to allow a full recovery from the uremic state associated with the late stages of non-dialysis chronic kidney disease.

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Section: Does Twice-weekly Dialysis Reduce Early Mortality Of Incidenmentioning

confidence: 95%

Section: Vascular Accessmentioning

confidence: 99%

Section: Is Twice-weekly Dialysis Associated With a Better Preservatimentioning

confidence: 99%

Section: Why Challenging An Hd Full Start?mentioning

confidence: 99%

Section: Incremental Hd Program and Hard Outcomesmentioning

confidence: 99%

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End-Stage Kidney Patients Require Hemodialysis Therapy Full Start

Chazot

Jean

2018

Blood Purif

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Incremental versus standard dialysis for people with kidney failure

Sabanayagam

Hegerty

et al. 2023

Cochrane Database of Systematic Reviews

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A mixed-method feasibility study of a novel transitional regime of incremental haemodialysis: study design and protocol

et al. 2021

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Background Incremental haemodialysis/haemodiafiltration (HD) may help reduce early mortality rates in patients starting HD. This mixed-method feasibility study aims to test the acceptability, tolerance and safety of a novel incremental HD regime, and to study its impact on parameters of patient wellbeing. Method We aim to enrol 20 patients who will commence HD twice-weekly with progressive increases in duration and frequency, achieving conventional treatment times over 15 weeks (incremental group). Participants will be followed-up for 6 months and will undergo regular tests including urine collections, bio-impedance analyses and quality-of-life questionnaires. Semi-structured interviews will be conducted to explore patients’ prior expectations from HD, their motivations for participation and experiences of receiving incremental HD. For comparison of safety and indicators of dialysis adequacy, a cohort of 40 matched patients who previously received conventional HD will be constructed from local dialysis records (historical controls). Results Data will be recorded on the numbers screened and proportions consented and completing the study (primary outcome). Incremental and conventional groups will be compared in terms of differences in blood pressure control, interdialytic weight changes, indicators of dialysis adequacy and differences in adverse and serious adverse events. In analyses restricted to incremental group, measurements of RRF, fluid load and quality-of-life during follow-up will be compared with baseline values. From patient interviews, a narrative description of key themes along with anonymised quotes will be presented. Conclusion Results from this study will address a significant knowledge gap in the prescription HD therapy and inform the development novel future therapy regimens.

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Comparison between incremental and thrice‐weekly haemodialysis: Systematic review and meta‐analysis

Abstract: An incremental therapeutic approach as a beginning HD regimen is associated with lower mortality and better preservation of greater residual renal function.

Cited by 22 publications

References 27 publications

End-Stage Kidney Patients Require Hemodialysis Therapy Full Start

End-Stage Kidney Patients Require Hemodialysis Therapy Full Start

Incremental versus standard dialysis for people with kidney failure

A mixed-method feasibility study of a novel transitional regime of incremental haemodialysis: study design and protocol

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