Translate this page into:
Predictive factors of hospitalization, comparison between conventional and incremental hemodialysis: Bi-centered retrospective cohort study
-
Received: ,
Accepted: ,
How to cite this article: Ben Mahmoud N, Hadj Brahim M, Abidi S, Ben Salem M, Ben Salah M, Bchir S, et al. Predictive factors of hospitalization, comparison between conventional and incremental hemodialysis: Bi-centered retrospective cohort study. World Adv Renal Med. 2026;2:69-75. doi: 10.25259/WARM_5_2026
Abstract
Objectives:
Chronic kidney disease (CKD) is a common condition that naturally progresses to end-stage renal disease and increasingly requires hemodialysis. Several questions have been raised about the differences between incremental and conventional hemodialysis with respect to the factors influencing the risk of hospitalization.
Material and Methods:
This is a bicentric retrospective cohort study conducted in two nephrology departments, focusing on hemodialysis patients from January 2018 to January 2023.
Results:
This study included 127 patients: A first group of 72 conventionally hemodialyzed (56.69%) and a second group of 55 incrementally hemodialyzed (43.30%), with a mean age of 54.97 ± 15.96 years. Men represented 58.3% of the population. Hypertension was present in 71.7% of patients, and 38.6% were diabetic. The initial nephropathies observed were as follows: Diabetic (30.7%), tubulointerstitial (25.2%), undetermined (16.5%), vascular (15%), primary glomerular (11%), and hereditary (1.6%). When comparing the two groups, there was no significant difference in anthropometric measurements. Interdialytic weight gain was significantly higher in group 1 (p < 0.001). In univariate analysis, the predictive factors for hospitalization were the conventional hemodialysis (HD) method (p = 0.005), pre-, per-, and post-HD hypertension, inadequate and unsatisfactory HD (respectively p = 10–3, p = 0.004), hyperkalemia (p = 0.004), and anuria (p = 0.003).
Conclusion:
Our results identified risk factors for hospitalization, and conventional hemodialysis was associated with an elevated risk of hospitalization. Therefore, it is crucial to adopt a holistic approach when making therapeutic decisions and to consider these risk factors to identify patients at high risk for hospitalization.
Keywords
Conventional
Hemodialysis
Hospitalization
Incremental
INTRODUCTION
Chronic kidney disease (CKD) is a major public health issue worldwide. It affects around 13% of the world’s population[1] and has a major impact on global health, being a direct cause of global morbidity and mortality and a major risk factor for cardiovascular disease, with exponential healthcare costs.[2] Its incidence has been rising steadily in recent years, and hemodialysis (HD) is being used more and more frequently. According to statistics from our Ministry of Health, the number of HD patients has quadrupled in <20 years, rising from 2,262 in 1994 to 8,900 in 2012, and is estimated to rise to over 12,000 by 2022.[2]
CKD naturally progresses towards the end stage and requires the use of support methods, including extra-renal purification.[3] A hypothesis has been put forward to the effect that a less frequent number of sessions at the start of HD treatment (one or two sessions) is associated with greater preservation of residual renal function () without compromising survival in patients with preserved RRF.[4]
It has been shown that starting HD at a progressive rate for end-stage patients is associated with a better quality of life and a reduction in costs, with the best results obtained when urea clearance is > 3 mL/min and urine volumes are >500 mL/day.[5,6]
Given the paucity of studies on this subject, we set ourselves the objective to identify the risk factors for hospitalizations in patients on incremental and conventional dialysis.
MATERIAL AND METHODS
Study population
This is a bi-centric, retrospective cohort study. It was conducted in two nephrology, dialysis, and renal transplantation departments and included chronic HD patients between January 2018 and January 2023. Data collection ended in January 2024. We included patients: Age > 18 years. - Chronic HD patients during the study in the two centers, Monastir and Mahdia (between January 2018 and January 2023). HD patients during their 1st year of dialysis at the Monastir and Mahdia centers.
The study was carried out in accordance with the World Medical Association Declaration of Helsinki and was performed in compliance with relevant laws and institutional guidelines.
Definitions of study variables
Incremental dialysis consists of reducing the dose of dialysis by reducing the duration of treatment, the number of days, or the efficiency of clearance.[4] It involves modifying the initial HD prescription, either by reducing the prescribed dose <3 times a week, or by reducing the prescribed dose of dialysis in certain patients with significant RRF, with the intention of increasing the intensity of dialysis.[5] Conventional dialysis refers to a 3-weekly treatment schedule, i.e., 3 sessions/week at full dose for 4 h/session. The KT/V index is used to measure the “dialysis dose” administered to a patient, which should make it possible to determine whether dialysis is “adequate.” Its calculation is complex and involves: K: The urea clearance of the dialyzer: T: The effective duration of dialysis; and V: Urea diffusion volume.
In general, dialysis is considered adequate when KT/V is >1.2, and satisfactory if KT/V is >1.4.[7] The patients collected were divided into two groups according to the number of HD sessions during the 1st year of dialysis: Group 1: Conventional HD and Group 2: Incremental HD.
Statistical analyses
Continuous variables are presented as mean ± standard deviation or median (range), with comparisons performed using Student’s t-test or Mann–Whitney U-test. Categorical variables are reported as numbers and percentages, and univariate analysis was performed using Pearson’s χ2-test or Fisher’s exact test. A p < 0.05 was considered statistically significant. All data were analyzed using Statistical Package for the Social Sciences (SPSS) software, version 22.0 (SPSS Inc., Chicago, IL, USA).
RESULTS
Patient characteristics
We included in our study 127 patients with CKD who started HD and were followed up in one of the two dialysis centers during the 6 years from 2018 to 2023. The mean incidence of patients on dialysis was 21.16 cases/year.
Patients were divided into two groups according to the HD protocol adopted [Figure 1]:
Group 1: 72 patients on conventional dialysis (56.7%)
Group 2: 55 patients on incremental dialysis (43.3%): 11 patients: 1 session/week; 44 patients: 2 sessions/week.
The mean age of patients was 54.97 ± 15.96 years, with extremes ranging from 15 to 93 years. Group 1 patients were significantly younger (50.82 ± 15.18 vs. 60.4 ± 15.44 years; p = 0.001).
A male predominance was observed in our study series (58.3% vs. 41.7%), i.e., an M/F sex ratio equal to 1.39.
In our series, 91 patients had hypertension (71.7%), 49 patients had diabetes (38.6%), 17 patients had dyslipidemia (13.4%), and 11 patients had cardiovascular disease (8.7%) [Table 1].
| Parameter | Total (n=127) | Group 1 (n=72) | Group 2 (n=55) | p-value |
|---|---|---|---|---|
| Age (years) | 54.97±15.96 | 50.82±15.18 | 60.4±15.44 | 0.001* |
| Sex, n (%) | ||||
| Male | 74 (58.3) | 50 (69.4) | 24 (43.6) | 0.003* |
| Female | 53 (41.7) | 22 (30.6) | 31 (56.4) | |
| Personnel medical history, n (%) | ||||
| HTN | 91 (71.7) | 53 (73.6) | 38 (69.1) | 0.575 |
| Diabetes | 49 (38.6) | 25 (34.7) | 24 (43.6) | 0.307 |
| Dyslipidemia | 17 (13.4) | 8 (11.1) | 9 (16.4) | 0.389 |
| Cardiovascular disease | 11 (8.7) | 5 (6.9) | 6 (10.9) | 0.530 |
The median BMI was 24.8 kg/m2 [22.5–27.6] with extremes ranging from 11.29 to 47.75 kg/m2. *p<0.05 was considered statistically significant. n: Number of patients, HTN: Hypertension, BMI: Body mass index
Median systolic blood pressure (SBP) was 130 mmHg (120– 140) and median mean arterial pressure was 86.6 mmHg (80–90).
Mean pre-dialysis SBP was significantly higher in group 1 (131.94 ± 17.81 mm Hg vs. 124.36 ± 11.34 mm Hg; p = 0.004). The mean MAP was higher in group 1 (87.4 ± 8.52 mm Hg vs. 84.12 ± 5.44 mm Hg, p = 0.009) [Table 2].
| Parameter | Total (n=127) | Group 1 (n=72) | Group 2 (n=55) | p-value |
|---|---|---|---|---|
| Weight (kg) | 70 (60–80) | 71.26±13.31 | 72.18±16.68 | 0.708 |
| Height (m) | 1.68 (1.62–1.72) | 1.67±0.08 | 1.66±0.07 | 0.280 |
| BMI (kg/m2) | 24.8 (22.5–25.6) | 25.21±4.16 | 25.78±5.09 | 0.297 |
| Normal BMI (18.5–24.9 kg/m2) | 64 (50.4%) | 38 (52.8%) | 26 (47.3%) | 0.539 |
| Obesity (>25kg/m2) | 63 (49.6%) | 34 (47.2%) | 29 (52.7%) | |
| Pre-dialysis SBP (mm Hg) | 130 (120–140) | 131.94±17.8 | 124.36±11.34 | 0.012* |
| Pre-dialysis DBP (mm Hg) | 60 (60–70) | 65.14±6.49 | 64±4.94 | 0.458 |
| Pre-dialysis MBP (mm Hg) | 86.6 (80–90) | 87.4±8.52 | 84.12±5.44 | 0.053 |
| Pre-dialysis HTN (SBP >130 and/or DBP>70) | 26 (20.5%) | 22 (30.6%) | 4 (7.3%) | 0.001* |
| Anuria (residual diuresis=0) | 66 (52%) | 64 (88.9%) | 2 (3.6%) | <0.001 * |
| Interdialytic weight gain (kg) | 3 (2–3) | 3.02±0.86 | 2.19±0.69 | <0.001* |
| Weight gain ≥2 kg | 109 (85.8%) | 66 (91.7%) | 43 (78.2%) | 0.031* |
*p<0.05 was considered statistically significant. n: Number of patients, BMI: Body mass index, HTN: Hypertension, SBP: Systolic blood pressure, DBP: Diastolic blood pressure, MBP: Mean blood pressure
The comparison of biological data between the two groups is shown in Table 3.
| Parameter | Total (n=127) | Group 1 (n=72) | Group 2 (n=55) | p-value |
|---|---|---|---|---|
| Pre-dialytic creatinine (µmoL/l) | 904.34±270.74 | 900.81±274.64 | 908.96±268 | 0.867 |
| Pre-dialytic urea (mmol/L) | 27.58±7.86 | 26.92±7.61 | 28.44±8.17 | 0.282 |
| eGFR (mL/min) | 8.43±3.94 | 8.86±3.61 | 7.86±4.31 | 0.161 |
| Targated hemoglobin (g/dL) | 9.31±1.93 | 9.16±1.96 | 9.53±1.87 | 0.286 |
| Anemia (%) | 74 (58.3) | 52 (72.2) | 22 (40) | <0.001* |
| Albuminemia (g/L) | 39.47±4.76 | 40.28±5.08 | 38.65±4.29 | 0.075 |
| Hypoalbuminemia | 2 (1.6%) | 2 (2.8%) | 0 (0%) | 0.505 |
| Protidemia (g/L) | 68.47±5.17 | 68.51±5.3 | 68.43±5.09 | 0.934 |
| Hypoprotidemia (%) | 2 (1.6) | 2 (2.8) | 0 (0) | 0.505 |
| Kaliemia (mmol/L) | 5.23±0.98 | 5.66±0.89 | 4.66±0.79 | <0.001* |
| Hyperkaliemia (%) | 54 (42.5) | 46 (63.9) | 8 (14.5) | <0.001* |
| Targeted calcemia (mmol/L) | 2.14±0.21 | 2.1±0.22 | 2.18±0.2 | 0.039* |
| Hypocalcemia (%) | 74 (58.3) | 48 (66.7) | 26 (47.3) | 0.028* |
| Targeted phosphatemia | 1.77±0.54 | 1.8±0.55 | 1.72±0.54 | 0.380 |
| Hyperphsophatemia (%) | 96 (75.6) | 58 (80.6) | 38 (69.1) | 0.136 |
| Uric acid (µmol/L) | 364.12±107.95 | 361.38±114.06 | 365.81±106.83 | 0.910 |
| Ferritin (ng/mL) | 411 (232–603) | 428.5 (258–615) | 326.5 (204–593) | 0.208 |
| Low ferritin (%) | 19 (15) | 7 (9.7) | 12 (21.8) | 0.058 |
| PTH (µg/L) | 425 (286.5–747) | 509,5 (288–1062) | 392 (286.5–645) | 0.171 |
| Triglycerides (g/L) | 1.4 (0.94–1.85) | 1.57±0.83 | 1.51±0.83 | 0.456 |
| Total cholesterol (mmol/L) | 3.7 (3.4–4.62) | 3.99±0.88 | 3.9±0.92 | 0.565 |
| LDL cholesterol (mmol/L) | 2.37±0.79 | 2.31±0.76 | 2.45±0.82 | 0.389 |
| HDL cholesterol (mmol/L) | 0.9 (0.75–1.14) | 0.95±0.32 | 1.21±1.33 | 0.167 |
*p<0.05 was considered statistically significant. eGFR: Estimated glomerular filtration rate, PTH: Parathyroid hormone, LDL: Low-density lipoprotein, HDL: High-density lipoprotein
We had significantly more hospital admissions in group 1 (31.9% vs. 10.9%; p = 0.005).
In univariate analysis, the predictive factors for hospitalization were the conventional HD method (p = 0.005), pre-, per-, and post-HD hypertension, inadequate and unsatisfactory HD (respectively p≤ 0.001, p = 0.004), hyperkalemia (p = 0.004), and anuria (p = 0.003) [Table 4].
| Parameter | Hospitalized (n=29) (%) | Non-hospitalized (n=98) (%) | p-value |
|---|---|---|---|
| Age (years) | 50.24 | 53.47 | 0.069 |
| Male | 19 (65.51) | 55 (56.12) | 0.069 |
| Female | 10 (34.48) | 43 (43.87) | |
| Conventional HD | 23 (79.31) | 51 (52.04) | 0.005* |
| Incremental HD | 6 (20.68) | 47 (47.95) | |
| Satisfactory HD | 14 (48.3) | 75 (76.5) | 0.001* |
| Weight | 69 [92–58.8] | 70 [130–30] | 0.255 |
| Height | 1.68 [1.8–1.55] | 1.68 [1.85–1.45] | 0.319 |
| BMI | 24.07 [33.20–21.25] | 25.38 [47.75–11.29] | 0.579 |
| Pre HD SBP | 135 [150–110] | 140 [160–90) | 0.002* |
| Pre HD DBP | 60 | 65 [60–80] | 0.013* |
| Per HD SBP | 130 [150–100] | 125 [160–80] | 0.002* |
| Per HD MBP | −3.66±5.7 | −4.62±4.7 | 0.013* |
| Post-HD DBP | 65 [60–70] | 60 [60–80] | 0.005* |
| Post-HD MBP | −1.89±5.5 | −2.65±4.8 | 0.028* |
| Pre-HD HTN | 11 (37.9) | 15 (15.3) | 0.008* |
| Per-HD HTN | 11 (37.9) | 15 (15.3) | 0.008* |
| Post-HD HTN | 8 (27.6) | 10 (10.2) | 0.018* |
| Hemoglobin (g/dL) | 9.33±1.83 | 10.45±1.93 | 0.501 |
| Anemia | 20 (69) | 54 (55.1) | 0.184 |
| Hypoalbuminemia (g/L) | 2 (6.9) | 0 (0) | 0.051 |
| Protidemia (g/L) | 64.5 [60–68] | 69 [82–65] | 0.175 |
| LDLc | 2.7 [1.69–4.6] | 2.28 [0.57–4.07] | 0.035* |
| Serum calcemia | 2.035 [1.56–2.45] | 2.17 [1.66–2.4] | 0.664 |
| Phosphatemia | 1.93 [0.78–2.8] | 1.8 [0.75–3.37] | 0.738 |
| Uric acid | 281 [274–439] | 369.5 [133–644] | 0.362 |
| Pre-HD urea | 29 [20–55] | 25.7 [12.6–48] | 0.413 |
| PRU>=65% | 14 (48.3) | 75 (76.5) | 0.004* |
| Kt/v | 1.63 [0.79–2.01] | 1.53 [0.51–2.27] | 0.007* |
| HD adequate | 18 (62.1) | 88 (89.8) | <0.001* |
| Kaliemia | 5.27 [3.6–7] | 5.1 [3.5–7.4] | 0.014* |
| Hyperkaliemia | 19 (65.5) | 35 (35.7) | 0.004* |
| Residual diuresis | 7 (24.13) | 54 (55.10) | 0.002* |
| Anuria | 22 (75.9) | 44 (44.9) | 0.003* |
*p<0.05 was considered statistically significant. HD: Hemodialysis, SBP: Systolic blood pressure, DBP: Diastolic blood pressure, MBP: Mean blood pressure, HTN: Hypertension, LDL: Low-density lipoprotein
The results of the multivariate analysis are shown in Table 5.
| Variables | OR | CI | p-value |
|---|---|---|---|
| SBP before HD | 1.048 | 0.985–1.193 | 0.1 |
| Hyperkalemia | 0.434 | 0.152–1.235 | 0.118 |
| DBP post HD | 1.061 | 0.956–1.178 | 0.264 |
| Adequacy | 3.429 | 1.162–10.121 | 0.026 |
| Anuria | 0.455 | 0.152–1.365 | 0.455 |
*p<0.05 was considered statistically significant. HD: Hemodialysis, SBP: Systolic blood pressure, DBP: Diastolic blood pressure, OR: Odds ratio, CI: Confidence interval
DISCUSSION
In our series, the mean age of patients was 54.97 ± 15.96 years. There was a slight male predominance (58.3% vs. 41.7%) with a sex ratio of 1.39:1. This was comparable to a study carried out, which reported a mean age of 60.2 ± 15.3 years and a sex ratio of 1.41,[8] and another study conducted, which included 88 patients with a mean age of 56 ± 18 years.[9] In Italy, in a meta-analysis of 22 studies, Garofalo et al.[10] reported that the mean age of patients was 62 years.
A Thai meta-analysis of 138, 939 participants showed that incremental dialysis preserves RRF and therefore diuresis more, with less inter-dialytic weight gain and overload.[11] This result was validated by Obi et al.[4] in their study, in which diuresis was preserved in 16% more cases in the twice-weekly dialysis population.
These results confirm that RRF makes a significant contribution to patient well-being. It allows the elimination of low-molecular-weight solutes and medium-molecular-weight uremic toxins, and helps to maintain water balance and control phosphate. It should not be forgotten that RRF is inversely related to valvular calcification and left ventricular hypertrophy in dialysis patients.[12]
In our cohort, there was no significant difference in pre-HD renal function tests.
Anemia was noted in 72.2% of patients receiving conventional HD, but patients receiving twice-weekly HD had less anemia, with a rate of 40%.
The data in the literature were discordant with regard to this result. A Thai cohort showed that there was no significant difference between the two groups in terms of hemoglobin levels.[13] These results were consistent with the data from a Korean study, which concluded that hemoglobin levels did not differ between the two groups.[14] A recent meta-analysis also came to the same conclusion.[15] Another Spanish study found the same result, but with less use of erythropoietin in the incremental group.[16]
Although some authors believe that incremental dialysis exposes patients to an additional cardiovascular risk due to the tendency toward hyperkalemia and hypervolemia, this risk appears to be mitigated by the preservation of RRF, which supports our findings.
In our study, the rate of hospitalizations was significantly higher in the conventional HD group (31.9% vs. 10.9%). The data in the literature differ from one series to another with regard to hospitalizations in the two populations.
A randomized American series including 48 patients, 23 of whom underwent incremental HD. With regard to the number of hospitalizations, 11 incrementally dialyzed patients were hospitalized for a total of 19 hospitalizations over 71 days. Twelve patients in the conventional group were hospitalized, with 33 hospitalizations for 172 days in total.[17]
In Italy, different series had different results. Caria et al.,[18] observing 68 patients over a total period of 24 months, found that hospitalizations were more frequent in the conventional group: a total of 24 hospitalizations for 15 patients over 147 days. Only 3 twice-weekly HD patients were hospitalized for 11 days. In Thailand, a prospective multicenter cohort of 673 patients found that those receiving incremental HD had a higher rate of hospitalization (25.4%) than those receiving HD 3 times a week (21.9%).
Our retrospective study has several limitations linked to the size of the sample. The small sample size reduces the statistical power of the analysis. Another limitation is the retrospective nature of the study, which exposes us to memory and coding biases.
To overcome these limitations, a prospective study with a larger and more representative sample would enable the results obtained to be confirmed and the relationships between the different variables to be explored more precisely.
CONCLUSION
Our series demonstrated the difference between the conventional and incremental techniques. It is therefore crucial to adopt a holistic approach when making therapeutic decisions and to take into account the various clinical and biological parameters of patients, with regular, targeted monitoring. The conventional dialysis, compared to incremental dialysis, is associated with a higher risk of hospitalization.
Our study has two main limitations. First, the type of retrospective study has limited control of sampling and poor control of exposure factors. Another limitation of our series is the small size of the population studied. Other prospective studies with larger numbers are needed to obtain more solid results.
Our findings will enable action to be taken to identify individuals at risk of hospitalization to reduce morbidity and mortality.
Author contributions:
NBM: Manuscript writing, patient management and data analysis; MHB: Manuscript writing, patient management and data analysis; SA: Manuscript writing, patient management and data analysis; Mar.BS: Manuscript review and validation; Man.BS: Manuscript review and validation; SB: Manuscript review and validation; AL: Manuscript review and validation; MH: Manuscript review and validation; ZE: Manuscript review and validation; HS: Manuscript review and validation.
Ethical approval:
The research/study approved by the Institutional Review Board at Faculty of Medicine of Monastir, number 25/2023, dated 12th January 2023.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understand that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.
Financial support and sponsorship: Nil.
References
- A narrative review of chronic kidney disease in clinical practice: Current challenges and future perspectives. Adv Ther. 2022;39:33-43.
- [CrossRef] [PubMed] [Google Scholar]
- Performance des centres d'hémodialyse au centre est tunisien : Conformité et adéquation des examens biologiques (Étude PHCET 2014) Rev Épidémiol Santé Publique. 2019;67:33-41.
- [CrossRef] [PubMed] [Google Scholar]
- Chronic kidney disease diagnosis and management: A review. JAMA. 2019;322:1294-304.
- [CrossRef] [PubMed] [Google Scholar]
- Incremental hemodialysis, residual kidney function, and mortality risk in incident dialysis patients: A cohort study. Am J Kidney Dis. 2016;68:256-65.
- [CrossRef] [PubMed] [Google Scholar]
- Incremental hemodialysis-a European perspective. Seminars Dial. 2017;30:270-6.
- [CrossRef] [PubMed] [Google Scholar]
- Incremental hemodialysis: What we know so far. Int J Nephrol Renovasc Dis. 2022;15:161-72.
- [CrossRef] [PubMed] [Google Scholar]
- Incremental dialysis: Review of the literature with pediatric perspective. Pediatr Nephrol. 2024;39:49-55.
- [CrossRef] [PubMed] [Google Scholar]
- Incremental and infrequent hemodialysis: A new paradigm for both dialysis initiation and conservative management. Panminerva Med. 2017;59:188-96.
- [CrossRef] [PubMed] [Google Scholar]
- Incremental dialysis in ESRD: Systematic review and meta-analysis. J Nephrol. 2019;32:823-36.
- [CrossRef] [PubMed] [Google Scholar]
- Incremental versus conventional haemodialysis in end-stage kidney disease: A systematic review and meta-analysis. Clin Kidney J. 2024;17:sfad280.
- [CrossRef] [PubMed] [Google Scholar]
- The importance of residual renal function in dialysis patients. Kidney Int. 2006;69:1726-32.
- [CrossRef] [PubMed] [Google Scholar]
- Dialysis dose and risk factors for death among esrd patients treated with twice-weekly hemodialysis: A prospective cohort study. Blood Purif. 2014;38:253-62.
- [CrossRef] [PubMed] [Google Scholar]
- Comparison of clinical outcome between twice-weekly and thrice-weekly hemodialysis in patients with residual kidney function. Medicine (Baltimore). 2016;95:e2767.
- [CrossRef] [PubMed] [Google Scholar]
- Comparison between incremental and thrice-weekly haemodialysis: Systematic review and meta-analysis. Nephrology (Carlton). 2019;24:438-44.
- [CrossRef] [PubMed] [Google Scholar]
- Individualized hemodialysis treatment: A perspective on residual kidney function and precision medicine in nephrology. Cardiorenal Med. 2019;9:69-82.
- [CrossRef] [PubMed] [Google Scholar]
- Twice-weekly hemodialysis with adjuvant pharmacotherapy and transition to thrice-weekly hemodialysis: A pilot study. Am J Kidney Dis. 2022;80:227-40.e1.
- [CrossRef] [PubMed] [Google Scholar]
- The incremental treatment of ESRD: A low-protein diet combined with weekly hemodialysis may be beneficial for selected patients. BMC Nephrol. 2014;15:172.
- [CrossRef] [PubMed] [Google Scholar]