Incremental hemodialysis has many potential benefits to patients clinicians and health systems.The aim of this work was to evaluate incremental hemodialysis twice/week compared with conventional dialysis thrice/week for preservation of the residual kidney function among patients initiating regular hemodialysis.Study design Prospective, comparative study.Setting Nephrology department Military Hospitals AL-maadi kobry AL-koba and air force military hospital.Subjects We assigned 40 patients with chronic kidney disease stage V D who early started hemodialysis into2 groups Group1:20 patients underwent incremental hemodialysis twice/week and Group2:20 patients underwent conventional hemodialysis thrice/week.Methods: All patients followed for laboratory findings of complete blood picture creatinine urea calcium albumin phosphorus parathyroid hormone alkaline phosphatase glomerular filtration rate. Also Kt/v at start and every month was done.Clinical outcome measures included mortality cardiovascular outcome hospital admission and dialysis complications.Results: In the studied population,the mean age was45.95±2.97 years.Regarding sex 60% were males and 40% were females. Regarding outcome data20%of patients had hypotension15%had hospital admission,while nobody suffered mortality.Comparative study betwee the 2 groups revealed; significant decrease in hypotension incidence in incremental group 40%compared to conventional group 10% p=0.03.Conclusion: To conclude, our study examines associations between HD treatment frequency and patient survival. In agreement with recent literature,30,31 our findings suggest that in an incident HD population, certain selected patients with adequate RKF, adequate control of interdialytic weight gain,and low or moderate comorbid disease burden CCI <5 an incremental HD approach