title: Progressive Hemodialysis: Is It The Future?
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.
authors.affiliation: Unit of Nephrology, Dialysis, Transplantation, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.|University of Pavia, Pavia, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Libetta
authors.affiliation: University of Pavia, Pavia, Italy.
authors.forename: Peni
authors.initials: P
authors.lastname: Nissani
authors.affiliation: Unit of Nephrology, Dialysis, Transplantation, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.|University of Pavia, Pavia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Dal Canton
mesh_terms: D000072700:Conservative Treatment; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010530:Peritoneal Dialysis; D006435:Renal Dialysis