Daijiworld Media Network - Mumbai
Mumbai, Jan 2: Initiating haemodialysis (HD) gradually instead of following the conventional thrice-a-week schedule may help patients with advanced kidney disease preserve their remaining kidney function and enjoy a better quality of life, according to a recent study.
Chronic kidney disease (CKD) affects millions globally, with haemodialysis being the most common treatment once kidney failure sets in. Traditionally, patients are started on three dialysis sessions per week, each lasting at least four hours. However, medical experts have increasingly questioned whether this aggressive approach hastens the loss of residual kidney function (RKF), the limited natural function that often remains when dialysis begins.
To examine this, researchers carried out a retrospective case-control study involving 80 patients with stage 5 CKD who began dialysis between January 2021 and January 2023. Half of the patients were started on incremental haemodialysis—either two four-hour sessions per week or three shorter weekly sessions—while the remaining half followed the standard thrice-weekly regimen. Both groups were matched for age, gender, cause of kidney disease, coexisting illnesses and baseline laboratory values.
The average age of the patients was nearly 64 years, with men accounting for half of the group. Diabetes and hypertension were the leading causes of kidney failure. During a two-year follow-up period, a small percentage of patients underwent kidney transplantation (3.8%), died (6.2%) or regained kidney function (2.5%).
The findings revealed a marked difference between the two approaches. About 45 per cent of patients who started on incremental dialysis retained residual kidney function, whereas none of the patients on standard dialysis did. Those on incremental HD also reported fewer infections—especially bloodstream infections—and maintained kidney function for a longer duration.
Importantly, they also reported a better quality of life.
The study noted no significant differences between the two groups in terms of cardiovascular complications, death rates or kidney transplantation. Factors linked to better preservation of residual kidney function included the use of incremental dialysis, higher blood albumin levels and the absence of bloodstream infections.
The researchers concluded that a gradual start to dialysis could offer clear benefits for carefully selected patients, allowing preservation of kidney function without increasing health risks. However, they stressed that larger, prospective clinical trials are needed before incremental dialysis can be widely adopted as a standard, patient-centred approach.