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Incremental dialysis: review of the literature with pediatric perspective

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Abstract

Drivers towards initiation of kidney replacement therapy in advanced chronic kidney disease include metabolic and fluid derangements, growth, and nutritional status with focus on health optimization. Once initiated, prescription of dialysis is often uniform despite variability in patient characteristics and etiology of kidney failure. Preservation of residual kidney function has been associated with improved outcomes in patients with advanced chronic kidney disease on dialysis. Incremental dialysis is the approach of reducing the dialysis dose by reduction in treatment time, days, or efficiency of clearance. Incremental dialysis has been described in adults at initiation of kidney replacement therapy, to better preserve residual kidney function and meet the individual needs of the patient. Consideration of incremental dialysis in pediatrics may be reasonable in a subset of children with continued emphasis on promotion of growth and development.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Department of Pediatrics, Seattle Children’s, University of Washington, Seattle, WA, USA

    Raj Munshi

  2. Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Sarah J. Swartz

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  1. Raj Munshi
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Correspondence to Raj Munshi.

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Raj Munshi has no conflict of interest. Sarah J. Swartz is a consultant/speaker for Fresenius Medical Care North America Jul 2021 through Dec 2021 to promote COVID vaccines in pediatrics.

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Munshi, R., Swartz, S.J. Incremental dialysis: review of the literature with pediatric perspective. Pediatr Nephrol 39, 49–55 (2024). https://doi.org/10.1007/s00467-023-06030-9

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