Incremental dialysis – up to 2 sessions a week – is an effective way to help patients transition into dialysis while still preserving residual renal function, a speaker said.
“It is important for patients to continue to make urine. It can represent up to a whole dialysis treatment per week,” Kamyar Kalantar-Zadeh, MD, MPH, PhD, said during a session at the American Nephrology Nurses Association Annual Symposium.
Developing a dialysis regimen that preserves kidney function and still offers needed therapy “helps to develop a sense of trust between me and my patients,” Kalantar-Zadeh, a professor of medicine at University of California-Irvine, said.
That means taking a different approach on how nephrology nurses can present therapeutic options to patients.
“In my practice, we don’t talk about starting on dialysis anymore,” Kalantar-Zadeh said. “We want to see the patient transition to dialysis. It is something that should happen gradually.”
Determining when to start incremental dialysis can be difficult.
“I still don't know that after 20 years of being a nephrologist,” Kalantar-Zadeh, who also practiced in Germany for several years, said. “Is it too early, too late?”
Incremental dialysis is part of a list of options that can also include conservative care – medical management without dialysis. However, Kalantar-Zadeh sees a dichotomy between incremental dialysis and conversative care.
“Incremental dialysis means preservative care – we are taking care of the kidney as the patient transitions into dialysis,” he said. “Conservative management is a different choice, but choice is what we need to offer all our patients.”
Kalantar-Zadeh said patients choose dialysis because they want to live longer, and he encourages that.
“I placed a patient who was 91 years old on dialysis; now, he is back to driving a car. We should offer all our patients all the options available to them,” he said.
Incremental is one of those options and it can offer an opportunity to retain residual renal function.
“We want to preserve that for all patients as long as possible,” Kalantar-Zadeh said.
Nieltje Gedney, who has been on home dialysis for the past 8 years, told attendees that incremental dialysis helps patients fulfill their goals while retaining residual renal function. For patients who are required to fit into the typical thrice-weekly dialysis regimen, “we are not applying precision medicine,” she said. “It’s not the right prescription for the right patient ... for me, less dialysis with the incremental approach was more.”