Australian Workshops on Patients’ Perspectives on Hemodialysis and Incremental Start

Katharine Hegerty, Allison Jaure, Nicole Scholes-Robertson, Angela Ju, Nicole Evangelidis, Martin Wolley, Amanda Baumgart, David W. Johnson, Carmel M. Hawley, Donna Reidlinger, Laura Hickey, Alyssa Welch, Yeoungjee Cho, Peter G. Kerr, Matthew A. Roberts, Jenny I. Shen, Jonathan Craig, Rathika Krishnasamy, Andrea K. Viecelli, INCremental dialysis to improve Health outcomes people starting Hemodialysis (INCH-HD) investigators

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Introduction: Most patients with kidney failure commence and continue hemodialysis (HD) thrice weekly. Incremental initiation (defined as HD less than thrice weekly) is increasingly considered to be safe and less burdensome, but little is known about patients’ perspectives. We aimed to describe patients’ priorities and concerns regarding incremental HD. 

Methods: Patients currently, previously, or soon to be receiving HD in Australia participated in two 90-minute online workshops to discuss views about HD focusing on incremental start and priorities for trial outcomes. Transcripts were analyzed using thematic analysis. Outcomes were ranked on the basis of the sum of participants’ priority scores (i.e., single allocation of 3 points for most important, 2 for second, and 1 for third most important outcome). 

Results: All 26 participants (1 caregiver and 25 patients) preferred an incremental HD approach. The top prioritized outcomes were quality of life (QOL) (56 points), residual kidney function (RKF) (27 points), and mortality (16 points). The following 4 themes underpinning outcome priorities, experience, and safety concerns were identified: (i) unpreparedness and pressure to adapt, (ii) disruption to daily living, (iii) threats to safety, and (iv) hope and future planning. 

Conclusion: Patients with kidney failure preferred an incremental start to HD to minimize disruption to daily living and reduce the negative impacts on their education, ability to work, and family life. QOL was the most critically important outcome, followed by RKF and survival.

Original languageEnglish
Pages (from-to)478-488
Number of pages11
JournalKidney International Reports
Issue number3
Early online date6 Dec 2022
Publication statusPublished - Mar 2023


  • hemodialysis
  • incremental dialysis
  • patient perspectives
  • patient-centered care
  • quality of life
  • residual kidney function


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