Incremental Hemodialysis: The TwoPlus Trial

This trial is testing whether people who are new to dialysis and still have some remaining kidney function can safely do twice-weekly dialysis sessions instead of the standard three sessions per week. The hypothesis is that twice-weekly dialysis may be sufficient for some patients while reducing burden and improving quality of life. **You may be eligible if...** - You are 18 years or older - You are new to dialysis (started within the past 12 weeks) - You still produce at least 500 mL of urine per day (indicating residual kidney function) - Your blood salt levels and acid-base balance are within acceptable ranges - Your kidney urea clearance is below a certain threshold, indicating you need dialysis support **You may NOT be eligible if...** - Your blood potassium is dangerously high, or your sodium or bicarbonate (acid-base) levels are critically abnormal - You are likely to need a kidney transplant, switch dialysis methods, or move centers within 6 months - You are pregnant or planning to become pregnant - You require large amounts of fluid removal at each dialysis session Talk to your doctor to see if this trial is right for you.