title: Application of a pattern of incremental haemodialysis, based on residual renal function, when starting renal replacement therapy.
abstract: BACKGROUND
  The interest in the preservation of residual kidney function on starting renal replacement therapy (RRT) is very common in techniques such as peritoneal dialysis but less so in haemodialysis (HD). In our centre the pattern of incremental dialysis (2 HD/week) has been an option for a group of patients. Here we share our experience with this regimen from March 2008.
  
  
  METHODS
  We included incident patients with residual diuresis >1,000ml/24h, clinical stability, absence of oedema, absence of hyperkalaemia >6.5 mEq/l and phosphoremia >6mg/dl, with acceptable comprehension of dietetic care. Exclusion criteria were: Clinical instability, no dietary or medical compliance and the afore mentioned laboratory abnormalities.
  
  
  RESULTS
  A total of 24patients were included in incremental technique. The mean age at start of RRT was 60 (15 years. The average time on incremental technique was 19 (18 months (range: 7-80), with a mean time on dialysis of 31 (23 months (range: 12-86). The reasons for transfer to thrice-weekly HD were: in 6patients due to laboratory tests, in 2patients for heart failure events, one for poor compliance and 3for receiving a kidney graft. The residual diuresis decreased in the first year from 2,106 (606ml/day to 1,545 (558 (P=.17) with the urea clearance and calculated residual renal function, basal 5.7 (1.5vs. 3.8 (1.9ml/min per year (P=.01) and basal 8.9 (2.4vs. 6.9 (4.3 per year (P=.28), respectively.
  
  
  CONCLUSIONS
  Incremental HD treatment, with twice-weekly HD, may be an alternative in selected patients. This approach can largely preserve residual renal function at least for the first year. Although this pattern probably is not applicable to all patients starting RRT, it can and should be an initial alternative to consider.
authors.affiliation: Sección de Nefrología, Hospital Universitario del Henares, Coslada (Madrid), España. Electronic address: jluis.merino@salud.madrid.org.
authors.forename: José L
authors.initials: JL
authors.lastname: Merino
authors.affiliation: Sección de Nefrología, Hospital Universitario del Henares, Coslada (Madrid), España.
authors.forename: Patricia
authors.initials: P
authors.lastname: Domínguez
authors.affiliation: Sección de Nefrología, Hospital Universitario del Henares, Coslada (Madrid), España.
authors.forename: Blanca
authors.initials: B
authors.lastname: Bueno
authors.affiliation: Sección de Nefrología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes (Madrid), España.
authors.forename: Yésika
authors.initials: Y
authors.lastname: Amézquita
authors.affiliation: Sección de Nefrología, Hospital Universitario del Henares, Coslada (Madrid), España.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Espejo
authors.affiliation: Sección de Nefrología, Hospital Universitario del Henares, Coslada (Madrid), España.
authors.forename: Vicente
authors.initials: V
authors.lastname: Paraíso
mesh_terms: D000368:Aged; D004231:Diuresis; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies
keywords: Diuresis residual; Diálisis incremental; Haemodialysis; Hemodiálisis; Incremental dialysis; Mortalidad; Mortality; Residual diuresis