A Gentler Approach to Dialysis May Help Preserve Your Kidneys' Remaining Function

Starting dialysis with a gentler, less intensive approach may help preserve the small amount of kidney function many patients still have when treatment begins. A new study found that 45% of patients who started with incremental dialysis retained their residual kidney function, while none of the patients on standard three-times-weekly dialysis did.

What Is Incremental Dialysis and How Does It Work?

Incremental dialysis means starting with either two four-hour sessions per week or three shorter weekly sessions, rather than the traditional three full sessions. Researchers studied 80 patients with stage 5 chronic kidney disease (CKD) who started dialysis between January 2021 and January 2023. Half began with incremental hemodialysis, while the other half followed the standard schedule.

The patients had a mean age of nearly 64 years, with diabetes and hypertension being the most common causes of kidney failure. Both groups were carefully matched for age, sex, underlying kidney disease, and other health conditions to ensure fair comparison.

What Benefits Did the Gentler Approach Provide?

Over the two-year follow-up period, patients on incremental dialysis experienced several advantages beyond preserving kidney function:

• Fewer Infections: Patients had significantly fewer bloodstream infections compared to those on standard dialysis schedules
• Better Quality of Life: Those receiving incremental dialysis reported improved daily living experiences
• Longer Function Preservation: Remaining kidney function lasted for extended periods compared to standard treatment

Importantly, the gentler approach didn't compromise safety. Researchers found no significant differences between the two groups in cardiovascular events, death rates, or transplantation rates.

Who Might Benefit Most from This Approach?

The study identified specific factors associated with better residual kidney function preservation. Patients with higher blood albumin levels and those who avoided bloodstream infections were more likely to maintain their remaining kidney function. The absence of infections appeared particularly important for preserving what natural kidney function remained.

Residual kidney function refers to the small amount of natural kidney filtering ability that many patients still have when they first need dialysis. This remaining function can help remove toxins and excess fluid from the body, potentially reducing the burden on artificial dialysis treatments.

While the findings are promising, the researchers emphasize that larger prospective clinical trials are still needed to confirm these results and guide wider adoption of incremental, patient-centered dialysis strategies. The study suggests that a one-size-fits-all approach to starting dialysis may not be optimal for all patients.