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Observations of twice a week hemodialysis. Incremental hemodialysis may offer substantial clinical, patient-centered, and cost benefits. In the largest and most rigorous study to date, Mathew et al. show that incremental hemodialysis is associated with satisfactory survival in those with adequate residual renal function and reasonable general health. While encouraging, these findings are a call to action for a suitably powered randomized clinical trial, to generate definitive evidence of benefit with this approach and define optimal practice for "real-world" implementation.