Outcomes of incident patients treated with incremental haemodialysis as compared with standard haemodialysis and peritoneal dialysis

Abstract

Residual kidney function is considered better preserved with incremental haemodialysis (I-HD) or peritoneal dialysis (PD) as compared to conventional thrice-weekly HD (TW-HD) and associated with improved survival. We aimed to describe outcomes of patients initiating dialysis with I-HD, TW-HD or PD. We conducted a retrospective analysis of a prospectively assembled cohort in a single university centre including all adults initiating dialysis from January 2013 to December 2020. Primary and secondary endpoints were overall survival and hospitalisation days at one year respectively. We included 313 patients with 234 starting on HD (166 TW-HD and 68 I-HD) and 79 on PD. At study end, 10 were still on I-HD while 45 transitioned to TW-HD after a mean duration of 9.8 +/- 9.1 months. Patients who stayed on I-HD were less frequently diabetics (p = 0.007). Mean follow-up was 33.1 +/- 30.8 months during which 124 (39.6%) patients died. Compared to patients on TW-HD, those on I-HD had improved survival (HR 0.49, 95% CI 0.26 to 0.93, p = 0.029), while those on PD had similar survival. Initial KRT modality was not significantly associated with hospitalisation days at one year. I-HD is suitable for selected patients starting dialysis and can be maintained for a significant amount of time before transition to TW-HD, with diabetes being a risk factor. Although hospitalisation days at one year are similar, initiation with I-HD is associated with improved survival as compared to TW-HD or PD. Results of randomized controlled trials are awaited prior to large-scale implementation of I-HD programs.