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Incremental Hemodialysis (pp. 69-90) $100.00
Authors:  (Kamonwan Tangvoraphonkchai and Andrew Davenport)
Incremental hemodialysis is based on the concept of adjusting the amount of dialysis
according to residual renal function, aiming to achieve a composite total urea clearance
target in order to minimize dialysis requirements and prolong residual renal function. Then,
when residual renal function is lost, more frequent or longer dialysis sessions,
hemodiafiltration or other therapies designed to increase middle molecule clearances ought
to be considered. Rather than the current paradigm of starting all patients on fixed dialysis
session times and frequency, incremental dialysis practice is personalized medicine,
individualizing the amount of dialysis for each patient. So, in patients with greater residual
renal function, dialysis is initiated with less frequent or shorter session times, but when
residual renal function declines, dialysis frequency or session times are then appropriately
increased to achieve dialysis targets. This approach, however, requires frequent monitoring
of residual renal function to ensure that patients do not receive suboptimal treatment. When
residual renal function is lost, then a more intensive approach, not only simply increasing
dialysis session duration, but also introducing hemodiafiltration, superflux dialysis, or
other therapies to target increased middle molecule and protein-bound solute clearance,
should be considered. 

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Incremental Hemodialysis (pp. 69-90)