Transition from Convention al Hemodialysis to Incremental Hemodialysis in a Patient with Stage V Chronic Kidney Disease – A Case Report

D.S., a a 77-year-old woman with end-stage diabetic nephropathy, initiated conventional hemodialysis (HD) on October 29, 2024, initially using a non-tunneled central venous catheter (CVC) as vascular access for the first two months, followed by the use of a native arteriovenous fistula (AVF). She managed to preserve a significant residual urine volume (>0.3–0.5 L/day), which prompted consideration of transitioning to incremental hemodialysis. From November 2024 until April 10, 2025, she underwent conventional hemodialysis three times per week (weekly treatment time [WTT] ~660–720 minutes), achieving high dialysis adequacy (spKt/V 1.40–1.78, URR ~75–83% per session). Hemoglobin remained stable (~10.0–11.2 g/dL) with transferrin saturation (TSAT) levels of 24–26% and ferritin levels of 450–520 μg/L, using modest doses of Epoetin (~4500-6000 IU/week). Interdialytic weight gains were minimal (-0.3-1.6% of dry weight), and mean arterial pressure (MAP) fluctuated around ~85–90 mmHg under antihypertensive therapy. S