Incremental haemodialysis (IHD), in which dialysis dose is adjusted to take into account residual kidney function (RKF) usually by starting dialysis twice rather than thrice weekly, has been associated with improved maintenance of RKF and improved survival in observational studies. Maintenance of RKF is itself associated with improved small and middle molecule clearance, better health-related quality of life, reduced erythropoietin requirements, reduced ultrafiltration requirements, and improved control of blood pressure, nutritional status and phosphate levels.
A number of renal units employ IHD, and a number of studies are also ongoing. In addition to patient benefits and cost savings, there are clear environmental sustainability benefits too: fewer dialysis sessions initially means lower consumption of energy, water, and consumables; less travel, and potentially lower pharmaceutical use.
One Renal Unit's experience and protocol are attached for perusal (with permission). It is hoped that some discussion might follow to further inform other dialysis centres considering implementing IHD.