Perspectives on Quality of Life, Vascular Access and Fluid Balance in Incremental Hemodialysis: A Narrative Review

Hemodialysis is an intensive treatment with a substantial time burden for patients. Generally, a standard hemodialysis schedule consists of three treatments per week, each lasting 4 hours. However, it can be debated whether this schedule is appropriate for all patients. Incremental hemodialysis refers to a treatment approach where hemodialysis is initiated with a less intensive schedule ( i.e ., fewer sessions per week) and gradually increased as residual kidney function declines. The effects of incremental hemodialysis on key outcomes-health-related quality of life, vascular access-related complications, and fluid overload-were discussed in this review. Although incremental hemodialysis is hypothesized to improve health-related quality of life, most studies found no significant difference. Similarly, most studies did not report significant differences in vascular access-related complications. Concerns have been raised regarding fluid overload due to extended intervals between sessions and underdialysis, especially when the transition to a thrice-weekly schedule is delayed. However, most studies found no difference in fluid overload related outcomes. Incremental hemodialysis is a promising, personalized treatment that could reduce the socioeconomic burden of dialysis. Given the methodologic limitations of available studies, ongoing trials will contribute to a clearer understanding of the role of incremental hemodialysis with varying residual kidney function at initiation.