Incremental Dialysis to Preserve Residual Kidney Function
Research type
Research Study
Full title
Does incremental initiation of haemodialysis preserve native kidney function? A multicentre feasibility randomised control trial
IRAS ID
219032
Contact name
Enric Vilar
Contact email
Sponsor organisation
East and North Hertfordshire NHS Trust
Duration of Study in the UK
2 years, 4 months, 2 days
Research summary
Patients who start haemodialysis usually retain some natural kidney function often for months or years after starting the treatment. Even a small amount of this natural kidney function can be helpful in reducing the need for dietary and fluid restriction. There is also some evidence of a survival benefit.
Most patients who commence haemodialysis start three times per week for 3.5-4 hours per session, irrespective of the amount of natural kidney function they may have. An alternative way is to take account of kidney function in prescribing the amount of dialysis. This may allow patients to start treatment needing to spend less time on dialysis or even to start just twice weekly. The amount of dialysis can be adjusted over time as natural kidney function declines. This is called “incremental haemodialysis”.
There are observational studies, including our own, suggesting that an incremental start to haemodialysis whereby dialysis dose is upwardly adjusted as natural kidney function falls may have benefits including slowing the rate of decline of natural kidney function, but this needs to be tested in a large randomised study. However to inform the design of such a study, a smaller scale feasibility study is required.
We intend to randomise fifty new starters with adequate natural kidney function into two groups – a group who will have dialysis prescribed in the traditional fashion – three times weekly for 3-4 hours per session or a group who will have an incremental start beginning with twice weekly treatment. We will investigate how many patients have sufficient natural kidney function to be eligible, whether patients are willing to participate and continue in the study, compare the rate of loss of kidney function between groups, and ascertain whether this individualised dialysis approach is less intrusive to patients. The results will be used to design a larger definitive study
REC name
East of England - Cambridge South Research Ethics Committee
REC reference
17/EE/0311
Date of REC Opinion
5 Sep 2017
REC opinion
Further Information Favourable Opinion