Centro Hospitalar de Lisboa Occidental


Centro Hospitalar de Lisboa Occidental (CHLO) has adopted incremental haemodialysis to personalize healthcare delivery. Incremental haemodialysis (iHD) involves gradually adjusting the dialysis prescription to provide a slower transition by performing it less frequently, e.g., twice a week.


Nephrology, primarily due to haemodialysis (HD), is one of the most environmentally impactful specialties.

HD consists of a renal replacement therapy typically administered three times a week, that is initiated in stage five chronic kidney disease and almost always started in “full dose”, regardless of the patient’s residual kidney function (RKF).

Recently, incremental haemodialysis (i.e., twice weekly) has gained attention due to the possibility of personalizing healthcare by adapting the treatment to the RKF and aiding the patient to become familiar with the treatment. Beyond these benefits, by decreasing the number of sessions while the patient still has RKF, this regimen might also be more environmentally friendly.

Solution proposed

CHLO has implemented a comprehensive protocol for incremental haemodialysis. Under this protocol, patients who meet the clinical inclusion criteria for initiating incremental haemodialysis are enrolled in the treatment scheme. A weekly evaluation is conducted to continuously reassess the fulfillment of these inclusion criteria. Should a patient no longer satisfy the criteria, a transition is made to conventional haemodialysis.

How is this innovative?

This project is innovative as the implementation of incremental haemodialysis remains uncommon in most nephrology departments. The topic has gained significant attention and discussion within the nephrology community in recent times.

Expected impact and vision of the project

In 2019, CHLO conducted a retrospective study with all incidental HD patients in the hospital that underwent conventional HD from the start. Differences among modalities (three times versus twice weekly) were calculated for 12 months. The study included 157 patients who were assessed against criteria to be included in an iHD programme. Twenty-three patients (15%) would have been eligible.

The expected reductions in one year for this number of patients are as follows:

  • 4186 kg of medical waste avoided, of which 1549 kg are plastic
  • Conservation of 386,400 litres of water
  • Reduction of 60,836 kg of CO2 emissions from transportation and treatment
  • Financial savings of EUR 36,164 from avoided cost


The implementation of personalized healthcare, such as incremental haemodialysis, offers various health co-benefits. One significant advantage is the potential improvement in mental health resulting from reduced time spent in the hospital. Another potential co-benefit is the possibility of better preservation of vascular access, particularly arteriovenous fistulas. While scientific evidence supporting this claim is not yet robust, there is a suggestion that residual renal function could be better maintained through incremental haemodialysis.

Written by:

IHF Secretariat