Background: Incremental hemodialysis is based on the simple idea of adjusting its dose according to the metrics of residual kidney function. Indeed, most patients initiating dialysis have some degree of residual kidney function. Incremental dialysis may preserve residual renal function and improve survival in comparison with full-dose dialysis. Objective: To compare the intervention arm (incremental hemodialysis) with the control arm (standard 3 hemodialysis sessions/week). Patients and Methods: A prospective cohort study was conducted, recruiting 50 patients from multiple hemodialysis units, over six months. The prevalent patients were divided randomly into equal two treated groups. The outcomes compared adequacy of hemodialysis and detection of hazards as well as complications, including vascular access failure and associated interventions, cardiovascular events and hospital admissions, and mortality in both groups.   Results: Regarding the occurrence of cardiovascular events, chest pain, there were no significant differences between both groups. Arrhythmia was not recorded in the incremental group, while in the conventional group it was recorded in 2 patients, and there was no significant difference between both groups. Regarding the need for hospital admission, there was no significant difference between both groups. As regards the occurrence of vascular access failure, it was recorded in 2 patients in the incremental group, compared to 4 patients in the conventional group, with no significant difference between both groups.Adequacyof hemodialysis (in the form of urea reduction ratio and KT/V) was better in the incremental group. Conclusion: Incremental hemodialysis was superior to the conventional one regarding the adequacy of dialysis, with monthly follow-up till 6 months. There were no significant differences between both groups regarding cardiovascular events, vascular access failure, and hospitalization.