Comparison of characteristics of centres practising Incremental and Conventional approaches to Haemodialysis Delivery and post-dialysis recovery times and patient survival

Introduction: Conventional haemodialysis (HD) involves treatment times of around 4 hours thrice weekly, taking no account of residual kidney function (RKF). In Incremental HD the frequency and duration of dialysis sessions are individualised according to RKF. There are no studies comparing these approaches. We utilised data from a recent multicentre study to compare patient characteristics and outcomes between a centre practising incremental HD and others using a conventional approach. Methods: 709 patients attending for routine outpatient HD in five UK centres were studied. One centre practiced incremental dialysis (n = 254) and four conventional HD (n = 455). Data collected included demographics, comorbidity, dialysis parameters, routine biochemistry and haematology, recovery time post-dialysis, and Beck depression inventory-II score (BDI-II). Patients were followed for a minimum of 12 months. Findings: Pre- and post-dialysis BP, serum calcium and phosphate were higher in the Incremental centre, whilst sessional Kt/Vurea was lower (all p < 0.001), as was the proportion of patients with a mean post-dialysis BP <100 mmHg (p = 0.011). Patients recovered from their HD session more quickly in the Incremental centre, with significantly more patients reporting recovery within one and four hours Short-term survival was significantly better in the Incremental centre both unadjusted and adjusted for age, gender, ethnicity, dialysis vintage, anuria, history of cancer, heart disease, diabetes mellitus, body mass index, serum albumin, BDI-II score, and sessional Kt/V. Discussion: The association between incremental dialysis, shorter post-dialysis recovery times and improved short-term survival may be related to reduced haemodynamic stress as a consequence of less intensive ultrafiltration and reduced length of dialysis sessions. Prospective studies are required to test this hypothesis.