Table 2.
List of Studies Comparing Incremental Dialysis Regimens with Traditional Thrice Weekly Dialysis Regimens
| Year (Dur) | Author/Country | No. of Incident Patients with RKF if Measured | Baseline GFR (mL/min) | Study Design | ||
|---|---|---|---|---|---|---|
| < 3x-HD | 3x-HD | |||||
| 1999 (3) | Hanson/USA36 | 570 | 14,497 | NA | RC | Mortality similar when adjusted for eGFR at time of dialysis initiation. |
| 2009 (8) | Lin/Taiwan37 | 23 | 51 | 3.4±1.4 | PC | 2x-HD group had a slower decline of RKF |
| 2010 (8) | Stankuviene/ Lithuania38 | 1007 2x-HD 879 1x-HD |
1425 | NA | RC | Dialysis limited by availability: 2x-HD had shorter survival |
| 2012 (5) | Fernandez/Spain39 | 41 | 54 | 6±2 | PC | 2x-HD group had greater survival (log-rank: 3.964; P=0.04). Loss in RKF and 24-hour diuresis was lower in 2x-HD. |
| 2012 (2) | Elamin/Sudan40 | 756 | 255 | NA | PC | 1-year survival in 2x-HD was 85% compared to 89% for SD (P=0.06) |
| 2012 (2) | Lin/China41 | 532 | 756 | NA | PC | 2x-HD had similar survival of SD |
| 2014 (1) | Panaput/Thailand42 | 61 | 169 | 4.4±2.3 | PC | 1 year survival rate was similar in 2x-HD and SD |
| 2014 (2) | Caria/Italy2 | 38 | 30 | 7.8±1.9 | PC | Volume output and RKF were maintained in the 1x-HD + low protein diet group; at 24 months survival rates were 94.7% vs 86.8% for 1x-HD vs SD |
| 2014 (1) | Zhang /China43 | 30 | 55 | 1.82±1.97 | PC | 2x-HD during the first year of dialysis therapy appears to be associated with better RKF preservation (10 vs 40%, p = 0.03). |
| 2016 (3) | Hwang/Korea44 | 113 | 137 | 61.0±14.2 | PC | Greater risk of mortality in 2x-HD compared with SD (in presence of RKF) |
| 2016 (4) | Obi/USA45 | 351 | 8068 | 4.8 | RC | 2x-HD associated with greater preservation of RKF while higher mortality observed after 1 year in those with lowest RKF |
| 2016 (5) | Mathew/USA46 | 434 | 50,162 | 5.4 | RC | No difference in mortality in 2x-HD compared to 3x-HD |
| 2017 (6) | Park/Korea34 | 105 | 207 | 7.5 ±3.4 | PC | No differences in survival and daily urine volume |
| 2017 (1.5) | Mukherjee/India47 | 35 | 82 | NA | RC | Greater risk of mortality with 2x-HD compared with 3x-HD; 3x-HD associated with increased levels of insurance coverage and affordability |
| 2018 (2.5) | Yan/China5 | 123 | 290 | NA | RC | No difference in survival or hospitalization noted in 2x-HD vs 3x-HD regardless of RKF. |
| 2020 (6) | Dai/China48 | 12 | 2 | >1–3 | MCT RCT | Comparable inflammatory and nutritional clinical outcomes and adverse events. Quality of life was better for 2x-HD. |
| 2021 (1) | Vilar/United Kingdom49 | 29 | 26 | 6.44/6.98 | MCT RCT | 2x-HD safe and associated with fewer adverse events and hospitalizations and lower cost. No discernable impact on rate of loss of RKF and quality of life. |
| 2021 (2) | Fang/China28 | 54/44 | 90/89 | Oliguric/anuric | PC | 2x-HD had worse volume status compared to 3x-HD especially for long-term dialysis vintage. B-type natriuretic peptide was predictor of mortality in HD patients. |
| 2021 (0.75) | Murea/USA50 | 23 | 25 | Clearance > 2 mL/min | MCT RCT | Preliminary results show 2x-HD confers better preservation of residual kidney function. All patients were switched to 3x-HD at week 7. |
Abbreviations: 1x-HD, once weekly dialysis; 2x-HD, twice weekly dialysis; 3x-HD, standard thrice weekly dialysis; Dur, duration in years; eGFR, estimated glomerular filtration rate; GFR, glomerular filtration rate; HD, hemodialysis; MCT RCT, multicenter randomized controlled trial; NA, not available; RC, retrospective cohort; RKF, residual kidney function; PC, prospective cohort; SD, standard dialysis ; USA, United States of America.