#4298 DOES STARTING RENAL REPLACEMENT THERAPY WITH INCREMENTAL HAEMODIALYSIS WORSEN OUTCOMES?

Abstract Background and Aims Most patients start maintenance haemodialysis (HD) with a fixed dose of 3 HD sessions per week (3HD/Wk), regardless their residual kidney function (RKF). This intense schedule is considered the “standard” or “conventional” modality (cHD). It widely accepted, no randomised controlled trial (RCT) has examined whether other less frequent schedules are inappropriate harmful. Thus, optimal for incident currently unknown. Incremental (iHD), on hand, adjusts frequency to RKF, increasing number compensate any subsequent reduction in RKF. While iHD approaches precision medicine by customising sessions, it raises concerns about long intersession periods risk under-dialysis. Pending ongoing RCTs [1], our aim analyse efficacy safety patients. Method The policy Centre try who clinically stable We 1 session (1HD/Wk) if RKF above 4 ml/min/1.73 m2 2 (2HD/Wk) between 2.5 m2. progress from 1HD/Wk 2HD/Wk 3HD/Wk depending ultrafiltration rates required, which assessed at least monthly. Since 2012, we have treated 186 iHD, whom 168 had follow up ≥ 90 days. 72% (128 patients) started remaining 28% (40 2HD/Wk. compared results 410 baseline receive sessions/Wk (cHD) 80 Peritoneal Dialysis (PD). also analysed 27 after 60 days were already dialysed (3HD/Wk/60d group). calculated mortality rate (deaths/365 %) each group survival technique (sessions not performed). Results mean age was higher than cHD PD (Table 1). Mortality similar patients, although latter younger. Patients stayed time group) highest Survival (time 50% remain iHD) 12 months, avoiding 86 sessions/patient. cost €17,200/patient (session + transport = €200). Conclusion efficient, as considerably reduces performed thus costs, thereby improving quality life. safe, cHD. Being more does worsen results. On contrary, requiring weekly beginning treatment may be associated poor prognosis.