Murea M, Patel A, Highland BR, et al. - Enrolling incident kidney dysfunction requiring dialysis patients into a randomized study of incremental-start hemodialysis (HD) with adjuvant pharmacotherapy who adhere to the study protocol during follow-up, is inferred to be a feasible strategy based on this study’s findings.

• In this pilot study, adults with estimated glomerular filtration rate ≥5 mL/min/1.73 m ² and urine volume ≥500 mL/24 h initiating maintenance HD were randomized to twice-weekly HD and adjuvant pharmacologic therapy for 6 weeks followed by thrice-weekly HD (incremental HD group; n=23) or thrice-weekly HD (conventional HD group; n=25).

• Adherence to HD schedule was 96% at mean follow-up of 281.9 days (22/23 and 24/25 in the incremental and conventional groups, respectively) and was 100% in both groups to serial timed urine collection.

• For all-cause hospitalization, the incidence rate ratio was estimated to be 0.31; and 7 deaths occurred (1 in the incremental and 6 in the conventional group).

• In the incremental HD group, a 51.0 percent lower decline in urine volume and 57.9 percent lower decline in the averaged urea and creatinine clearances was noted at week 24.