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Kidney Week

Abstract: TH-PO339

Incremental and Twice Weekly Hemodialysis in Australia and New Zealand

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Wolley, Martin, University of Queensland, Brisbane, Queensland, Australia
  • Hawley, Carmel M., Princess Alexandra Hospital, Brisbane, Queensland, Australia
  • Marshall, Mark R., Middlemore Hospital, Auckland, New Zealand
  • Roberts, Matthew A., Eastern Health, Blackburn, Victoria, Australia

Most patients with end stage kidney failure starting hemodialysis do so at a standard frequency of three times a week, with occasional patients starting at a twice weekly frequency (“incremental dialysis”). Incremental dialysis may preserve residual kidney function, and has been associated with reduced mortality in dialysis patients. In this study we aimed to report the prevalence of incremental dialysis in an Australian and New Zealand incident dialysis cohort, and outcomes associated with this approach.


A cohort of incident adult patients starting hemodialysis between 2004 and 2015 was created. We constructed multivariate Cox proportional hazards models with a primary exposure of dialysis frequency at the first survey date. The primary outcome was all-cause mortality with secondary outcomes of cardiovascular and non-cardiovascular mortality.


The cohort comprised 27513 subjects with complete dialysis frequency data, with 970528 patient months of follow up. Of these, 850 started on twice weekly hemodialysis and 783 had complete data for analysis. Compared to patients starting on conventional dialysis, those started on incremental dialysis were older (67 vs 62 years, p<0.001), had a lower BMI (26.1 vs 27.7 kg/m2, p<0.001), were more likely to be female (45% vs 38%, p<0.001) had a higher eGFR at dialysis start (7.59 vs 6.66ml/min P<0.001) and were less likely to have diabetes (39.2% vs 50.2%, p<0.001). In a multivariate cox model, incremental start dialysis was not associated with reduced hazards for all-cause mortality (HR 1.03, 95% CI 0.92 – 1.16) but in death cause-specific models was associated with an increased risk for non-cardiovascular mortality (HR 1.25, 95% 1.11 – 1.42) but not cardiovascular mortality (HR 0.87, 95% CI 0.71 – 1.07).


In this cohort, incremental dialysis was used infrequently and there was evidence of patient level differences which imply specific selection criteria are used in practice. Outcomes overall were similar, but cause specific mortality risks demonstrated increased non-cardiovascular mortality risks in the incremental cohort, likely reflecting the differences in patient characteristics. A prospective trial to test the safety and efficacy of incremental dialysis should be considered.