الفهرس 
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Abstract
Introduction: The prevalence of ESKD in increasing worldwide. Kidney replacement therapy options include kidney transplantation, maintenance hemo- and peritoneal dialysis. Despite advances in hemodialysis techniques, quality of life remains low and mortality is high among dialysis patients. In hemodialysis, thrice weekly HD is the prevalent regimen for HD initiation. However, this doesn’t represent the ideal regimen, as it doesn’t take into account the remaining RKF. Materials and methods: This study was carried out to compare different clinical outcomes between incremental and conventional HD initiation. Patients with residual urine volume <0.5 L/day who recently initiated HD were recruited. Patients were followed up for 2 years for a primary outcome of mortality and numerous secondary clinical outcomes. Results: There were significantly lower all-cause mortality among the IIHD group compared to conventional thrice weekly HD after 2 years follow up. Moreover, mortality occurred significantly earlier among the conventional HD group, and there were more CV deaths in the conventional group as well. IIHD had significantly more preservation of RKF and RUV, less reduction in the LVEF from baseline, lower direct cost of care, less decrease in SF-12 physical and mental health components from baseline, lower phosphorus and PTH levels, less VA complications namely hematoma, compared to conventional HD group. Both IIHD and conventional thrice weekly HD groups had similar rate of hospitalization, anemia profile, and serum calcium levels. In the view of the non-randomized nature of our study, and the potential for selection bias, randomized controlled trials are much awaited to prove the safety and efficacy of IIHD regimen of HD initiation for patients with RKF. Conclusion: Individualized incremental hemodialysis program, in comparison to conventional thrice-weekly HD, provided better survival, lower cardiovascular mortality, more preservation of RKF, cost reduction, better QOL, better control of phosphorus and parathyroid hormone levels (through preservation of RKF), and lower vascular access complications.