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. 2022 Nov 23;37(12):2514-2521.
doi: 10.1093/ndt/gfac205.

Outcomes of incident patients treated with incremental haemodialysis as compared with standard haemodialysis and peritoneal dialysis

David A Jaques  1 , Belen Ponte  1 , Fadi Haidar  1 , Anne Dufey  1 , Sebastian Carballo  2 , Sophie De Seigneux  1 , Patrick Saudan  1
Affiliations

Outcomes of incident patients treated with incremental haemodialysis as compared with standard haemodialysis and peritoneal dialysis

David A Jaques et al. Nephrol Dial Transplant. .

Abstract

Background: Residual kidney function is considered better preserved with incremental haemodialysis (I-HD) or peritoneal dialysis (PD) as compared with conventional thrice-weekly HD (TW-HD) and is associated with improved survival. We aimed to describe outcomes of patients initiating dialysis with I-HD, TW-HD or PD.

Methods: We conducted a retrospective analysis of a prospectively assembled cohort in a single university centre including all adults initiating dialysis from January 2013 to December 2020. Primary and secondary endpoints were overall survival and hospitalization days at 1 year, respectively.

Results: We included 313 patients with 234 starting on HD (166 TW-HD and 68 I-HD) and 79 on PD. At the end of the study, 10 were still on I-HD while 45 transitioned to TW-HD after a mean duration of 9.8 ± 9.1 months. Patients who stayed on I-HD were less frequently diabetics (P = .007). Mean follow-up was 33.1 ± 30.8 months during which 124 (39.6%) patients died. Compared with patients on TW-HD, those on I-HD had improved survival (hazard ratio 0.49, 95% confidence interval 0.26-0.93, P = .029), while those on PD had similar survival. Initial kidney replacement therapy modality was not significantly associated with hospitalization days at 1 year.

Conclusions: I-HD is suitable for selected patients starting dialysis and can be maintained for a significant amount of time before transition to TW-HD, with diabetes being a risk factor. Although hospitalization days at 1 year are similar, initiation with I-HD is associated with improved survival as compared with TW-HD or PD. Results of randomized controlled trials are awaited prior to large-scale implementation of I-HD programmes.

Keywords: incremental haemodialysis; mortality; outcomes; peritoneal dialysis; survival.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Kaplan–Meier survivor function according to initial KRT modality.
Figure 2:
Figure 2:
Multivariate Cox survivor function according to initial KRT modality. Multivariate model is adjusted for the following covariates: age, gender, Charlson score, urgent KRT initiation and access type.
See this image and copyright information in PMC

Comment in

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