Progressive Hemodialysis: Is It The Future?

Semin Dial. 2016 May;29(3):179-83. doi: 10.1111/sdi.12455. Epub 2015 Nov 15.

Abstract

Progressive hemodialysis is based on the simple idea of adjusting its dose according to residual renal function (RRF). The progressive, infrequent paradigm is slowly gaining a foothold among nephrologists, despite a lot of skepticism in the scientific world. Given the importance of RRF preservation in conservative therapy, it seems a contradiction to ignore the contribution of RRF when patients initiate hemodialysis (HD), especially when it is routinely considered with peritoneal dialysis. While a three-times-weekly HD regimen is broadly considered the standard starting regimen for new patients, twice-weekly HD has been used in selected patients and is currently a common practice in South-East Asia. Small studies indicate that a once-weekly HD regimen may be a viable starting option as well. Progressive hemodialysis still requires validation, yet it is promising. We share the belief that a randomized clinical trial to investigate progressive hemodialysis is much needed, but we also strongly recommend including a once-weekly HD starting dose as part of any such investigation.

Publication types

  • Editorial

MeSH terms

  • Conservative Treatment
  • Humans
  • Kidney / physiopathology
  • Kidney Failure, Chronic / therapy*
  • Peritoneal Dialysis
  • Renal Dialysis*