{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T01:03:02Z","timestamp":1790643782213,"version":"4.1.0"},"reference-count":50,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Seminars in Dialysis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Hemodialysis, the most commonly employed renal replacement therapy in end\u2010stage kidney disease, prescriptions have long been standardized as thrice\u2010weekly at full\u2010dose; however, HD implementation is not without major complications. Incremental HD modalities are developed to face such one\u2010size\u2010fits\u2010all approach with hopes for better preservation of residual kidney function, better quality of life and patient compliance, lower complication rates, and improvements in morbidity and mortality. A comprehensive literature search was conducted through PubMed, Scopus, the Cochrane Library, Web of Science, and Ovid MEDLINE to identify relevant clinical studies on the efficacy and safety of incremental HD modalities over standard of care HD approach. We have included a total of 35 clinical studies in our final meta\u2010analysis. Our analysis has revealed that incremental HD approach was not associated with statistically significant improvement in all\u2010cause mortality, hospitalization rates, cardiovascular events, intradialytic hypotension or quality of life including mental, and physical components compared to standardized HD approach. Incremental hemodialysis was associated with better preservation of residual kidney function and lower rates of vascular access complications. Incremental hemodialysis was associated with non\u2010inferior clinical outcomes, better preservation of residual kidney function, and fewer vascular access complications than standard thrice\u2010weekly hemodialysis. Larger prospective studies with longer follow\u2010up are needed to support its widespread clinical use.<\/jats:p>","DOI":"10.1111\/sdi.70048","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:47:00Z","timestamp":1790642820000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and Safety of Incremental Hemodialysis: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7995-4488","authenticated-orcid":false,"given":"Berk","family":"Mizrak","sequence":"first","affiliation":[{"name":"Department of Medicine Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidar","family":"Copur","sequence":"additional","affiliation":[{"name":"Department of Medicine Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6297-5215","authenticated-orcid":false,"given":"Francesco Gaetano","family":"Casino","sequence":"additional","affiliation":[{"name":"Associazione Nefrologica Gabriella Sebastio  Martina Franca Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8152-5471","authenticated-orcid":false,"given":"Carlo","family":"Basile","sequence":"additional","affiliation":[{"name":"Associazione Nefrologica Gabriella Sebastio  Martina Franca Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1297-0675","authenticated-orcid":false,"given":"Mehmet","family":"Kanbay","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"issue":"8","key":"e_1_2_6_2_1","doi-asserted-by":"crossref","first-page":"e1378","DOI":"10.1016\/S2214-109X(25)00198-6","article-title":"Global, Regional, and National Prevalence of Kidney Failure With Replacement Therapy and Associated Aetiologies, 1990\u20132023: A Systematic Analysis for the Global Burden of Disease Study 2023","volume":"13","author":"Rafferty Q.","year":"2025","journal-title":"Lancet Global Health"},{"issue":"1","key":"e_1_2_6_3_1","doi-asserted-by":"crossref","first-page":"27","DOI":"10.3390\/kidneydial4010003","article-title":"One\u2010Size\u2010Does\u2010Not\u2010Fit\u2010All: The Case of Incremental Hemodialysis","volume":"4","author":"Casino F. G.","year":"2024","journal-title":"Kidney and Dialysis"},{"issue":"11","key":"e_1_2_6_4_1","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1080\/14737159.2021.1987216","article-title":"Toward an Individualized Determination of Dialysis Adequacy: A Narrative Review With Special Emphasis on Incremental Hemodialysis","volume":"21","author":"Torreggiani M.","year":"2021","journal-title":"Expert Review of Molecular Diagnostics"},{"issue":"1","key":"e_1_2_6_5_1","doi-asserted-by":"crossref","first-page":"89","DOI":"10.2215\/CJN.01170905","article-title":"Predictors of Early Mortality Among Incident US Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS)","volume":"2","author":"Bradbury B. D.","year":"2007","journal-title":"Clinical Journal of the American Society of Nephrology"},{"issue":"4","key":"e_1_2_6_6_1","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1007\/s40620-017-0391-0","article-title":"Is Incremental Hemodialysis Ready to Return on the Scene? From Empiricism to Kinetic Modelling","volume":"30","author":"Basile C.","year":"2017","journal-title":"Journal of Nephrology"},{"key":"e_1_2_6_7_1","doi-asserted-by":"crossref","first-page":"161","DOI":"10.2147\/IJNRD.S286947","article-title":"Incremental Hemodialysis: What We Know so Far","volume":"15","author":"Soi V.","year":"2022","journal-title":"International Journal of Nephrology and Renovascular Disease"},{"issue":"2","key":"e_1_2_6_8_1","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1093\/ndt\/gfac274","article-title":"Impact of Incremental Initiation of Haemodialysis on Mortality: A Systematic Review and Meta\u2010Analysis","volume":"38","author":"Caton E.","year":"2023","journal-title":"Nephrology, Dialysis, Transplantation"},{"issue":"5","key":"e_1_2_6_9_1","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1007\/s40620-018-00577-9","article-title":"Incremental Dialysis in ESRD: Systematic Review and Meta\u2010Analysis","volume":"32","author":"Garofalo C.","year":"2019","journal-title":"Journal of Nephrology"},{"issue":"4","key":"e_1_2_6_10_1","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1111\/nep.13252","article-title":"Comparison Between Incremental and Thrice\u2010Weekly Haemodialysis: Systematic Review and Meta\u2010Analysis","volume":"24","author":"Liu Y.","year":"2019","journal-title":"Nephrology (Carlton)"},{"key":"e_1_2_6_11_1","unstructured":"G. A.Wells.The Newcastle\u2013Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta\u2010Analyses. Available at:http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp. accessed December 17 2025."},{"key":"e_1_2_6_12_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A Revised Tool for Assessing Risk of Bias in Randomised Trials","volume":"366","author":"Sterne J. A. 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S.","year":"2020","journal-title":"BMC Nephrology"},{"issue":"20","key":"e_1_2_6_36_1","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000020202","article-title":"Impact of Twice\u2010 or Three\u2010Times\u2010Weekly Maintenance Hemodialysis on Patient Outcomes: A Multicenter Randomized Trial","volume":"99","author":"Dai L.","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"e_1_2_6_37_1","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.2147\/TCRM.S332218","article-title":"Benefits of Incremental Hemodialysis Seen in a Historical Cohort Study","volume":"17","author":"Chen W.","year":"2021","journal-title":"Therapeutics and Clinical Risk Management"},{"issue":"2","key":"e_1_2_6_38_1","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1053\/j.ajkd.2021.12.001","article-title":"Twice\u2010Weekly Hemodialysis With Adjuvant Pharmacotherapy and Transition to Thrice\u2010Weekly Hemodialysis: A Pilot Study","volume":"80","author":"Murea M.","year":"2022","journal-title":"American Journal of Kidney Diseases"},{"issue":"3","key":"e_1_2_6_39_1","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1007\/s11255-020-02697-3","article-title":"Comparison of Nutritional and Hydration Status in Patients Undergoing Twice and Thrice\u2010Weekly Hemodialysis: A Silent Drama in Developing Countries","volume":"53","author":"Nieves\u2010Anaya I.","year":"2021","journal-title":"International Urology and Nephrology"},{"issue":"3","key":"e_1_2_6_40_1","article-title":"Could Incremental Haemodialysis Be a New Standard of Care? 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M.","year":"2022","journal-title":"Egyptian Journal of Hospital Medicine"},{"issue":"9","key":"e_1_2_6_45_1","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.2215\/CJN.0000000000000507","article-title":"Twice Weekly Versus Thrice Weekly Hemodialysis\u2010A Pilot Cross\u2010Over Equivalence Trial","volume":"19","author":"Lee S.","year":"2024","journal-title":"Clinical Journal of the American Society of Nephrology"},{"issue":"11","key":"e_1_2_6_46_1","doi-asserted-by":"crossref","first-page":"3796","DOI":"10.1016\/j.ekir.2025.08.043","article-title":"Pilot Randomized Trial of Dialysis Less Frequently in the Elderly: The DLITE Study","volume":"10","author":"White C. 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