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

Abstract

Aim: Incremental haemodialysis (HD) regimen has recently gained attention. However, its efficacy and safety, compared with conventional thrice-weekly HD, are controversial and previous research results are not convincing. We sought to conduct a meta-analysis to evaluate the benefits and limitations of incremental HD regimen in patients with end-stage renal disease.

Methods: We searched PubMed, Embase, and the Cochrane Central Register databases for controlled trials published until January 2017. Outcomes of interest included baseline patient characteristics, mortality risk, renal function, urine volume, laboratory values, and hospitalization rate.

Results: Overall, 16 studies (n = 252 330), including 15 observational studies and 1 cross-sectional study, were included. Incremental HD reduced mortality risk, compared with conventional HD (risk ratio [RR], 0.797; 95% confidence interval [CI], 0.731-0.870; P < 0.001; I² = 0%). Renal function (standardized mean difference [SMD] = 0.677, 95% CI: 0.035 to 1.318, P = 0.039; I² = 92.7%) and urine volume (weighted mean difference [WMD] = 333.37, 95% CI: 86.81 to 579.93, P = 0.008; I² = 92.7%) were also better preserved in patients on incremental HD. Other clinical outcomes, including serum levels of calcium, phosphate, albumin, haemoglobin, and hospitalization rate, were similar between groups.

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

Keywords: dialysis initiation; incremental haemodialysis; meta-analysis; mortality; residual renal function.