The authors reply

We acknowledge the comments by Torreggiani et al.1 on our feasibility randomized controlled trial of incremental dialysis 2 regarding the timing of initiating incremental dialysis. We randomized patients within 3 months of initiating hemodialysis rather than from day 1. The question is whether we inadvertently reduced the benefit and effect size of the intervention with respect to the rate of loss of residual kidney function. Our approach was pragmatic and designed to exclude patients with acute kidney injuries to maximize the likelihood of this small study meeting its objectives. We agree that in routine clinical practice there would be no need for this degree of rigor. However, we doubt the slight delay in initiating incremental dialysis jeopardized residual kidney function because mean baseline glomerular filtration rate was 6 ml/min per 1.73 m2 in both groups.