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Kidney Week

Abstract: PO0883

Knowledge and Practice of Incremental Dialysis: A Survey of Canadian Nephrologists

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Dahiya, Anita, University of Alberta, Edmonton, Alberta, Canada
  • Bello, Aminu K., University of Alberta, Edmonton, Alberta, Canada
  • Thompson, Stephanie E., University of Alberta, Edmonton, Alberta, Canada
  • Schick-Makaroff, Kara, University of Alberta, Edmonton, Alberta, Canada
  • Pannu, Neesh I., University of Alberta, Edmonton, Alberta, Canada

Incremental hemodialysis, a strategy to individualize dialysis prescription at initiation, is being linked to enhanced quality of life and acceptability by patients and decreased health care costs. We aimed to explore knowledge and practice pattern regarding facility-based incremental hemodialysis in Canada.


A web-based survey of nephrologists, elicited current incremental hemodialysis (HD) prescribing practices, clinical and patient factors used to determine suitability for treatment, and potential barriers to implementation. The survey was circulated over a period of six weeks (September 21, 2020 and October 30, 2020).


The overall response rates 35% (243/691 nephrologists surveyed). Majority (66/111, 59%) of respondents prescribed incremental HD using an individualized approach at the discretion of the nephrologist. Most centers (200/203, 98%) did not report policy or guidance for implementation. Residual urine output was identified as the most important factor for eligibility (112/172, 65%), electrolyte stability (76/172,44%) and existing patient goals of care (69/117, 40%). The majority of nephrologists agreed that dialysis prescriptions are dynamic and should take residual kidney function into consideration; however, 74% of nephrologists did not think there was strong evidence supporting incremental dialysis. Potential barriers identified were patient safety, logistics of scheduling, limited evidence, and acceptance of dose escalation. Despite these barriers, 82% of participants felt that that facility-based incremental dialysis is feasible with their current resources and 78% agreed that with specific exclusion and inclusion criteria, incremental dialysis is a safe option.


Incremental hemodialysis is commonly practiced amongst Canadian nephrologists despite a lack of formal criteria for initiation and treatment escalation. This highlights a need for research to guide policy and practice for incremental hemodialysis in Canada.