Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Journal of Nephrology
Published in: Journal of Nephrology 5/2019

01-10-2019 | Peritoneal Dialysis | Original Article

Incremental dialysis in ESRD: systematic review and meta-analysis

Authors: Carlo Garofalo, Silvio Borrelli, Toni De Stefano, Michele Provenzano, Michele Andreucci, Gianfranca Cabiddu, Vincenzo La Milia, Valerio Vizzardi, Massimo Sandrini, Giovanni Cancarini, Adamasco Cupisti, Vincenzo Bellizzi, Roberto Russo, Paolo Chiodini, Roberto Minutolo, Giuseppe Conte, Luca De Nicola

Published in: Journal of Nephrology | Issue 5/2019

Login to get access

Abstract

Background

Incremental dialysis may preserve residual renal function and improve survival in comparison with full-dose dialysis; however, available evidence is limited. We therefore compared all-cause mortality and residual kidney function (RKF) loss in incremental and full-dose dialysis and time to full-dose dialysis in incremental hemodialysis (IHD) and incremental peritoneal dialysis (IPD).

Methods

We performed a systematic review and meta-analysis of cohort studies of adults with ESRD starting IHD and IPD. We identified in PubMed and Web of Science database all cohort studies evaluating incremental dialysis evaluating three outcomes: all-cause mortality, RKF loss, time to full dialysis. IPD was defined as < 3 daily dwells in Continuous Ambulatory Peritoneal Dialysis and < 5 sessions per week in Automated Peritoneal Dialysis, while IHD was defined as < 3 HD sessions per week.

Results

22 studies (75,292 participants), 15 in HD and 7 in PD, were analyzed. Mean age at dialysis start was 62 and 57 years in IHD and IPD subjects, respectively. When compared to full dose, incremental dialysis (IHD or IPD) had an overall mortality risk of 1.14 [95% CI 0.85–1.52] with high heterogeneity among studies (I2 86%, P < 0.001), and lower mean RKF loss (− 0.58 ml/min/months, 95% CI 0.16–1.01, P = 0.007). Overall, time to full-dose dialysis was 12.1 months (95% CI 9.8–14.3) with no difference between IHD and IPD (P = 0.217).

Conclusions

Incremental dialysis allows longer preservation of RKF thus deferring full-dose dialysis, by about 1 year in HD and PD, with no increase in mortality risk. Large and adequate studies are needed to confirm these findings.
Appendix
Available only for authorised users
Literature
1.
Pacilio M, Minutolo R, Garofalo C, Liberti ME, Conte G, De Nicola L (2016) Stage 5-CKD under nephrology care: to dialyze or not to dialyze, that is the question. J Nephrol 29(2):153–161CrossRefPubMed
2.
United States Renal Data System (2015) USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda
3.
ERA-EDTA Registry: ERA-EDTA Registry Annual Report (2013) Academic Medical Center. Department of Medical Informatics, Amsterdam
4.
5.
Vanholder R, Lameire N, Annemans L, Van Biesen W (2016) Cost of renal replacement: how to help as many as possible while keeping expenses reasonable? Nephrol Dial Transpl 31(8):1251–1261CrossRef
6.
Eckardt K, Gillespie I, Kronenberg F et al (2015) High cardiovascular event rates occur within the first weeks of starting hemodialysis. Kidney Int 88(5):1117–1125CrossRefPubMedPubMedCentral
7.
Zareba W (2015) Initiation of dialysis: trigger or cause of cardiovascular events? Kidney Int 88(5):942–944CrossRefPubMed
8.
Selby NM, Lambie SH, Camici PG, Baker CS, McIntyre CW (2006) Occurrence of regional left ventricular dysfunction in patients undergoing standard and biofeedback dialysis. Am J Kidney Dis 47(5):830–841CrossRefPubMed
9.
McIntyre CW, Burton JO, Selby NM et al (2008) Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. Clin J Am Soc Nephrol 3(1):19–26CrossRefPubMedPubMedCentral
10.
Burton JO, Jefferies HJ, Selby NM, McIntyre CW (2009) Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol 4(12):1925–1931CrossRefPubMedPubMedCentral
11.
McIntyre CW (2010) Haemodialysis-induced myocardial stunning in chronic kidney disease—a new aspect of cardiovascular disease. Blood Purif 292:105–110CrossRef
12.
Quinn RR, Hux JE, Oliver MJ et al (2011) Selection bias explains apparent differential mortality between dialysis modalities. J Am Soc Nephrol 22(8):1534–1542CrossRefPubMedPubMedCentral
13.
Yeates K, Zhu N, Vonesh E et al (2012) Hemodialysis and peritoneal dialysis are associated with similar outcomes for end-stage renal disease treatment in Canada. Nephrol Dial Transpl 27(9):3568–3575CrossRef
14.
Mehrotra R, Chiu YW, Kalantar-Zadeh K et al (2011) Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease. Arch Intern Med 171(2):110–118CrossRefPubMed
15.
Kumar VA, Sidell MA, Jones JP, Vonesh EF (2014) Survival of propensity matched incident peritoneal and hemodialysis patients in a United States health care system. Kidney Int 86(5):1016–1022CrossRefPubMed
16.
Basile C, Casino FG, Kalantar-Zadeh K (2017) Is incremental hemodialysis ready to return on the scene? From empiricism to kinetic modelling. J Nephrol 30(4):521–529CrossRefPubMed
17.
Kalantar-Zadeh K, Crowley ST, Beddhu S et al (2017) Renal replacement therapy and incremental hemodialysis for veterans with advanced chronic kidney disease. Semin Dial 30(3):251–261CrossRefPubMedPubMedCentral
18.
19.
Kalantar-Zadeh K, Kovesdy CP, Streja E et al (2017) Transition of care from pre-dialysis prelude to renal replacement therapy: the blueprints of emerging research in advanced chronic kidney disease. Nephrol Dial Transpl 32(suppl_2):ii91–ii98CrossRef
20.
21.
22.
Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012CrossRefPubMed
23.
24.
25.
26.
Tobias A (1999) Assessing the influence of a single study in the meta-analysis estimate. Stata Tech Bull 8(47):15–17
27.
Van Houwelingen HC, Arends LR, Stijnen T (2002) Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 21(4):589–624CrossRefPubMed
28.
Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101CrossRefPubMed
29.
Fernández-Lucas M, Teruel-Briones JL, Gomis-Couto A, Villacorta-Pérez J, Quereda-Rodríguez-Navarro C (2012) Maintaining residual renal function in patients on haemodialysis: 5-year experience using a progressively increasing dialysis regimen. Nefrologia 32(6):767–776PubMed
30.
Mathew A, Obi Y, Rhee CM et al (2016) Treatment frequency and mortality among incident hemodialysis patients in the United States comparing incremental with standard and more frequent dialysis. Kidney Int 90(5):1071–1079CrossRefPubMed
31.
Merino JL, Domínguez P, Bueno B, Amézquita Y, Espejo B, Paraíso V (2017) Application of a pattern of incremental haemodialysis, based on residual renal function, when starting renal replacement therapy. Nefrologia 37(1):39–46CrossRefPubMed
32.
Ghahremani-Ghajar M, Rojas-Bautista V, Lau WL et al (2017) Incremental hemodialysis: the University of California Irvine experience. Semin Dial 30(3):262–269CrossRefPubMedPubMedCentral
33.
Hanson JA, Hulbert-Shearon TE, Ojo AO et al (1999) Prescription of twice-weekly hemodialysis in the USA. Am J Nephrol 19(6):625–633CrossRefPubMed
34.
Stankuvienė A, Ziginskienė E, Kuzminskis V, Bumblytė IA (2010) Impact of hemodialysis dose and frequency on survival of patients on chronic hemodialysis in Lithuania during 1998–2005. Medicina (Kaunas) 46(8):516–521CrossRef
35.
Lin X, Yan Y, Ni Z et al (2012) Clinical outcome of twice-weekly hemodialysis patients in shanghai. Blood Purif 33(1–3):66–72CrossRefPubMed
36.
Elamin S, Abu-Aisha H (2012) Reaching target hemoglobin level and having a functioning arteriovenous fistula significantly improve one year survival in twice weekly hemodialysis. Arab J Nephrol Transpl 5(2):81–86
37.
Caria S, Cupisti A, Sau G, Bolasco P (2014) The incremental treatment of ESRD: a low-protein diet combined with weekly hemodialysis may be beneficial for selected patients. BMC Nephrol 15:172CrossRefPubMedPubMedCentral
38.
Hwang HS, Hong YA, Yoon HE et al (2016) Comparison of clinical outcome between twice-weekly and thrice-weekly hemodialysis in patients with residual kidney function. Medicine (Baltimore) 95(7):e2767CrossRef
39.
Park JI, Park JT, Kim YL et al (2017) Comparison of outcomes between the incremental and thrice-weekly initiation of hemodialysis: a propensity-matched study of a prospective cohort in Korea. Nephrol Dial Transpl 32(2):355–363
40.
Obi Y, Streja E, Rhee CM et al (2016) incremental hemodialysis, residual kidney function, and mortality risk in incident dialysis patients: a cohort study. Am J Kidney Dis 68(2):256–265CrossRefPubMedPubMedCentral
41.
Lin YF, Huang JW, Wu MS et al (2009) Comparison of residual renal function in patients undergoing twice-weekly versus three-times-weekly haemodialysis. Nephrology (Carlton) 14(1):59–64CrossRef
42.
Panaput T, Thinkhamrop B, Domrongkitchaiporn S et al (2014) Dialysis dose and risk factors for death among ESRD patients treated with twice-weekly hemodialysis: a prospective cohort study. Blood Purif 38(3–4):253–262CrossRefPubMed
43.
Mukherjee T, Devi G, Geetha S, Anchan NJ, Sankarasubbaiyan S (2017) A comparison of practice pattern and outcome of twice-weekly and thrice-weekly hemodialysis patients. Indian J Nephrol 27(3):185–189CrossRefPubMedPubMedCentral
44.
45.
De Vecchi AF, Scalamogna A, Finazzi S, Colucci P, Ponticelli C (2000) Preliminary evaluation of incremental peritoneal dialysis in 25 patients. Perit Dial Int 20(4):412–417PubMed
46.
Neri L, Viglino G, Cappelletti A, Gandolfo C, Barbieri S (2003) Incremental dialysis with automated peritoneal dialysis. Adv Perit Dial 19:93–96PubMed
47.
48.
Jeloka T, Sanwaria P, Chaudhari L, Periera A (2013) “Ico-Alone” single nocturnal exchange to initiate peritoneal dialysis in patients with residual renal function-Five year, single centre experience. Indian J Nephrol 23(4):276–279CrossRefPubMedPubMedCentral
49.
50.
51.
Kalantar-Zadeh K, Unruh M, Zager PG et al (2014) Twice-weekly and incremental hemodialysis treatment for initiation of kidney replacement therapy. Am J Kidney Dis 64(2):181–186CrossRefPubMedPubMedCentral
52.
Morelli E, Baldi R, Barsotti G et al (1987) Combined therapy for selected chronic uremic patients: infrequent hemodialysis and nutritional management. Nephron 47(3):161–166CrossRefPubMed
53.
Locatelli F, Andrulli S, Pontoriero G, Di Filippo S, Bigi MC (1994) Supplemented low-protein diet and once weekly hemodialysis. Am J Kidney Dis 24(2):192–204CrossRefPubMed
54.
Penne EL, van der Weerd NC, Blankestijn PJ et al (2010) Role of residual kidney function and convective volume on change in beta2-microglobulin levels in hemodiafiltration patients. Clin J Am Soc Nephrol 5(1):80–86CrossRefPubMedPubMedCentral
55.
Fry AC, Singh DK, Chandna SM, Farrington K (2007) Relative importance of residual renal function and convection in determining beta-2-microglobulin levels in high-flux haemodialysis and on-line haemodiafiltration. Blood Purif 25(3):295–302CrossRefPubMed
56.
Gerhardt T, Pöge U, Stoffel-Wagner B et al (2008) Serum levels of beta-trace protein and its association to diuresis in haemodialysis patients. Nephrol Dial Transpl 23(1):309–314CrossRef
57.
Krediet RT (2006) How to preserve residual renal function in patients with chronic kidney disease and on dialysis? Nephrol Dial Transpl 21(Suppl 2):ii42–ii46CrossRef
58.
Yang PY, Lin JL, Lin-Tan DT et al (2009) Residual daily urine volume association with inflammation and nutrition status in maintenance hemodialysis patients. Ren Fail 31(6):423–430CrossRefPubMed
59.
Tian JP, Du FH, Cheng LT, Wang T (2009) Residual renal function and arterial stiffness mediated the blood pressure change during interdialytic weight gain in hemodialysis patients. Hemodial Int 13(4):479–486CrossRefPubMed
60.
61.
Golper TA, Mehrotra R (2015) The intact nephron hypothesis in reverse: an argument to support incremental dialysis. Nephrol Dial Transpl 30(10):1602–1604CrossRef
62.
Roggeri A, Roggeri DP, Zocchetti C, Bersani M, Conte F (2017) ReNe (Renal Lombardy Network); additional contributors from ReNe Network. Healthcare costs of the progression of chronic kidney disease and different dialysis techniques estimated through administrative database analysis. J Nephrol 30(2):263–269CrossRefPubMed
63.
Bolasco P, Cupisti A, Locatelli F, Caria S, Kalantar-Zadeh K (2016) Dietary management of incremental transition to dialysis therapy: once-weekly hemodialysis combined with low-protein diet. J Ren Nutr 26(6):352–359CrossRefPubMed
64.
Mathew AT, Obi Y, Rhee CM, Chou JA, Kalantar-Zadeh K (2018) Incremental dialysis for preserving residual kidney function-Does one size fit all when initiating dialysis? Semin Dial 31(4):343–352CrossRefPubMedPubMedCentral
Metadata
Title
Incremental dialysis in ESRD: systematic review and meta-analysis
Authors
Carlo Garofalo
Silvio Borrelli
Toni De Stefano
Michele Provenzano
Michele Andreucci
Gianfranca Cabiddu
Vincenzo La Milia
Valerio Vizzardi
Massimo Sandrini
Giovanni Cancarini
Adamasco Cupisti
Vincenzo Bellizzi
Roberto Russo
Paolo Chiodini
Roberto Minutolo
Giuseppe Conte
Luca De Nicola
Publication date
01-10-2019
Publisher
Springer International Publishing
Published in
Journal of Nephrology / Issue 5/2019
Print ISSN: 1121-8428
Electronic ISSN: 1724-6059
DOI
https://doi.org/10.1007/s40620-018-00577-9

Other articles of this Issue 5/2019

Journal of Nephrology 5/2019 Go to the issue

Original Article

Interferon-free regimens improve kidney function in patients with chronic hepatitis C infection

Original Article

The relationship between the concentration of plasma homocysteine and chronic kidney disease: a cross sectional study of a large cohort

Original Article

Improvement in wound healing, pain, and quality of life after 12 weeks of SNF472 treatment: a phase 2 open-label study of patients with calciphylaxis

Editorial

Homocysteine and chronic kidney disease: an ongoing narrative

Correction

Correction to: Role of anemia and proteinuria in the development of subsequent renal function deterioration in a general population with preserved glomerular filtration rate: a community-based cohort study

Commentary

Calciphylaxis: a conundrum for patients and nephrologists?
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits