Incremental hemodialysis (incrHD) is not widely used nor is it well understood. In addition, and perhaps with more impact, governmental regulations in the United States and their consequential influences on dialysis provider organizations have made the practice of incrHD more difficult than traditional thrice weekly in-center HD. IncrHD is critically dependent on the amount of residual kidney function (RKF) as well as the individualized goals of end-stage renal disease (ESRD) management. RKF has to be assessed frequently and dialysis adjusted accordingly. Home HD lends itself to an incremental approach more so than in-center HD. This may be due to more experience of the provider, more knowledge of the therapy by the patient and family, the availability of dialysis platforms conducive to incrHD, and/or that its less onerous regulation by the government. I have had a long and successful experience performing incremental dialysis (both peritoneal and hemodialysis) and share here my practice strategies and approaches for incrHD.
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