Incremental Hemodialysis: The TwoPlus Trial

Patient eligibility Criteria: Inclusion Criteria: * Clinical Inclusion Criteria: * Age ≥ 18 years * Incident kidney dysfunction requiring dialysis (KDRD) started on maintenance, in-center hemodialysis (HD), or anticipated to be started on maintenance, in-center HD within the next 12 weeks * Has received ≤36 sessions of intermittent HD (i.e., on HD for ≤12 weeks) at the time patient is approached for potential study participation Residual Kidney Function Inclusion Criteria: * Kidney urea clearance \<2.0 mL/min * Urine volume# of ≥500 mL/24 h Exclusion Criteria: * Pre-HD serum K ≥5.8 mEq/L, Na ≤125 mEq/L, or bicarbonate level ≤17 mEq/L * Requirement or anticipated requirement of high-volume ultrafiltration * Unable or unwilling to follow the study protocol for any reason * Known pregnancy or planning to attempt to become pregnant or lactating women * Estimated survival or dialysis modality change or center transfer \<6 months Caregiver Eligibility Criteria: * be at least 18 years old * be the main caregiver (at patient's choice) * be a close relative of the patient (spouse, child, sibling, parent, grandchild) * have no known psychiatric and neurologic disorders (through direct inquiry from the person) * not be a member of the medical or healthcare team * not be the caregiver for another patient with chronic illness * not have experienced severe life events within prior 3 months of enrollment (through direct inquiry from the person)