Incremental dialysis: two complementary views

Clinical Kidney Journal, vol. 17, pp. sfae020

Abstract

Franco Casino and Mariana Murea discuss today's knowledge about the 'incremental dialysis' concept. Franco Casino frames the problem by saying that, in the presence of substantial residual kidney function, kidney replacement therapy can begin with low doses and/or frequencies, to be gradually increased to compensate for any subsequent losses of residual kidney function, keeping the total clearance above the minimum levels of adequacy. He remarks that studies so far have documented that this approach is safe. He recognizes that adequate randomized controlled trials (RCTs) are necessary to confirm the safety and simplify and standardize the practical aspects of this approach. Mariana Murea objects that most of the evidence gathered so far primarily derives from retrospective and observational studies, which can be influenced by socioeconomic constraints. She argues for the need for RCTs to provide compelling empirical evidence on the efficacy of incremental dialysis. Nephrologists are still reluctant to adopt this approach for various reasons, including unfamiliarity with the method, lack of practical guidance and financial disincentives. Several countries have ongoing or planned RCTs comparing incremental dialysis with conventional dialysis. These trials can shift the haemodialysis paradigm if they validate the safety and effectiveness of this approach. The moderators believe that the results of ongoing trials must be carefully interpreted, and further validation may be needed across different patient populations or healthcare settings. The ultimate goal is to gather robust evidence that could lead to widespread adoption of incremental haemodialysis, optimizing treatment, reducing overtreatment, preserving resources and improving patients' quality of life.

Authors 4

1. Francesco Gaetano Casino

   Ospedale Madonna Delle Grazie

   Affiliation as printed

   Department of Internal Medicine, Division of Nephrology, Hospital Madonna delle Grazie , Matera , Italy

2. Mariana Murea corresponding

   Wake Forest University Health Sciences · Wake Forest University

   Affiliation as printed

   Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine , Winston-Salem, NC , USA

   Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA

3. Jürgen Floege Aachen Division of Nephrology and Rheumatology

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Division of Nephrology and Rheumatology, RWTH Aachen University Hospital , Aachen , Germany

4. Carmine Zoccali

   Biogem · Renal Research Institute

   Affiliation as printed

   BIOGEM , Ariano Irpino , Italy

   IPNET , Reggio Cal , Italy

   Renal Research Institute NY , USA