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Kidney Week

Abstract: PO2533

Incremental HD in the US: A Multicenter Pilot Controlled Trial

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Murea, Mariana, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
  • Russell, Gregory B., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States

Incremental HD—twice-weekly initiation followed by thrice-weekly HD—is uncommonly prescribed in the US. We conducted a pilot trial to assess the feasibility and safety of incremental-start HD.


Adults with eGFR ≥5.0mL/min/1.73m2 and urine volume ≥500mL/day initiated on maintenance HD at 14 centers were randomly assigned to twice-weekly HD and adjuvant pharmacologic therapy (loop diuretics, sodium bicarbonate, patiromer) for 6 weeks, then transitioned to thrice-weekly HD (incremental HD) (n=23) vs continued thrice-weekly HD (conventional HD) (n=25). Intervention was embedded in usual care.


Adherence to assigned HD schedules and serial timed urine collection was 96% and 100%, respectively, in both groups. Two patients in incremental group switched to thrice-weekly HD in <6 weeks (Figure). There were fewer hospitalizations and deaths in incremental group (Table 1). Between-group differences in % change from baseline to week 26 in urine volume and renal average urea and creatinine clearance favored incremental HD (Table 2).


Incremetnal HD is feasible. Larger multicenter clinical trials are indicated to determine the efficacy and safety of incremental HD with longer twice-weekly HD periods.

Table 1
Serious adverse eventsIncremental HD (n=21)Conventional HD (n=22)
Total number of patients hospitalized1112
Total number of hospitalizations1933
Cumulative hospitalization rate, per person-year (95% CI)1.06 (0.95 - 1.16)1.84 (1.70 - 1.98)
Length of hospital stay, days, median (1st - 3rd quartile)
(per hospitalization, per person)
2.0 (2.0 - 5.0)5.0 (2.5 - 6.5)

Table 2

Figure 1


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