February 18, 2026

Incremental hemodialysis may improve quality of life for some patients

A recent study explores patients’ and health care providers’ experiences with incremental hemodialysis (iHD), where eligible patients begin dialysis twice a week instead of the usual three times weekly.  

Conventional hemodialysis is typically provided three times per week. Incremental hemodialysis is an alternative approach in which people with end-stage kidney disease who still have some remaining kidney function may start with fewer sessions each week.  

Montreal-based researcher Noémie Laurier and colleagues conducted semi-structured interviews with 10 patients who were either currently receiving iHD or had previously received it, along with five health care providers involved in their care. All participants were recruited from a single dialysis centre between March and May 2024.  

Patients reported that iHD improved their quality of life. Having one fewer dialysis session per week gave them more time for daily activities and reduced travel and financial strain compared to conventional dialysis. Health care providers also recognized these quality-of-life benefits. 

However, several challenges were identified. Patients described starting iHD as emotionally difficult, with stress levels similar to those experienced on a traditional three-times-weekly schedule. Care coordination was sometimes inconsistent, and patients had fewer opportunities to see their nephrologist. Health care providers also reported knowledge gaps about iHD and a lack of formal guidance for its use.  

Additionally, transitions from twice-weekly dialysis to a more frequent schedule were described as emotionally and practically challenging. Some patients were reluctant to increase their dialysis frequency, even when it was medically necessary.  

While the study was small and conducted at a single centre, the authors conclude that although iHD may offer quality-of-life benefits, improvements in education, care coordination, and clinical guidance are needed to support safe and effective implementation in broader clinical practice.