Application of model of incremental haemodialysis, based on residual renal function, at the initiation of renal replacement therapy

Introduction: The interest in the preservation of residual kidney function on starting renal replacement therapy (RRT) is very common in techniques such as peritoneal dialysis but less so in haemodialysis (HD). In our center the pattern of incremental dialysis (2 HD/week) has been an option for a group of patients. Here we share our experience with this regimen from March 2008. Material and methods: We included incident patients with residual diuresis >1000 ml/24 h, clinical stability, absence of edema, absence of hyperkalaemia >6.5 mEq/l and phosphoremia >6 mg/dl, with acceptable comprehension of dietetic care. Exclusion criteria were: clinical instability, no dietary or medical compliance and the afore mentioned laboratory abnormalities. Results: A total of 24 patients were included in incremental technique. The mean age at start of RRT was 60 ± 15 years. The average time on incremental technique was 19 ± 18 months (range: 7–80), with a mean time on dialysis of 31 ± 23 months (range: 12–86). The reasons for transfer to thrice-weekly HD were: in 6 patients due to laboratory tests, in 2 patients for heart failure events, one for poor compliance and 3 for receiving a kidney graft. The residual diuresis decreased in the first year from 2106 ± 606 ml/day to 1545 ± 558 (p = .17) with the urea clearance and calculated residual renal function, basal 5.7 ± 1.5 vs 3.8 ± 1.9 ml/min per year (p = .01) and basal 8.9 ± 2.4 vs 6.9 ± 4.3 per year (p = .28), respectively. Conclusions: Incremental HD treatment, with twice-weekly HD, may be an alternative in selected patients. This approach can largely preserve residual renal function at least for the first year. Although this pattern probably is not applicable to all patients starting RRT, it can and should be an initial alternative to consider.