Comparative Study between Incremental Hemodialysis and Conventional Thrice Weekly Hemodialysis in Prevalent Hemodialysis Patients

Abstract

Abstract Background The concept of incremental dialysis is inherent to the increasingly accepted idea of a new patient-centered prescription of dialysis. Objective To compare the intervention arm (incremental HD) with the control arm (standard3 HD/week).Incident patients will be randomized to one of the two treatment groups in equal proportion. Primary outcome is the preservation of RKF assessed as time to anuria (UO < 100 mL/day). Secondary outcomes are all-cause mortality and significant events, including vascular access failure and associated interventions, cardiovascular events and hospital admissions. Patients and Methods Type of Study: Prospective cohort study. Study Setting: Multi centric patients selectionfrom hemodialysis units. Study period: 6 months. Results These findings support the assumption in hand, that a twice weekly regimen is in fact adequate for preserving the RKF. As regarding the occurrence of cerebrovascular events, chest pain, there were no statistically significant differences between the two groups. Arrhythmia was not recorded in the incremental group, while in the conventional group it was recorded in 2 patients with a percentage of 8.0%, and there was no statistically significant difference between the two groups; P-value was 0.490. As regarding the need for hospital admission, there was no significant difference between both groups. As regarding the occurrence of vascular access failure, it was recorded in 2 patients in the incremental group with a percentage of 8.0%, compared to 4 patients in the conventional group with a percentage of 16.0%. There was no significant difference between the two groups; P-value was 0.667. Conclusion HD, RCTs are lacking and are urgently needed. If the potential benefits of incremental HD will be confirmed by RCTs, then starting dialysis at a full dose will be subjecting patients to unnecessarily long or more frequent treatments for an unnecessarily long time, and at higher cost.