Incremental Peritoneal Dialysis Favourably Compares with Hemodialysis as a Bridge to Renal Transplantation

Abstract

Background. The value of incremental peritoneal dialysis (PD) as a bridge to renal transplantation (Tx) has not been specifically addressed. Methods. All consecutive Stage 5 CKD patients with at least 1 year predialysis followup, starting incremental PD or HD under our care and subsequently receiving their first renal Tx were included in this observational cohort study. Age, gender, BMI, underlying nephropathy, residual renal function (RRF) loss rate before dialysis and RRF at RRT start, comorbidity, RRT schedules and adequacy measures, dialysis-related morbidity, Tx waiting time, RRF at Tx, incidence of delayed graft function (DGF), in-hospital stay for Tx, serum creatinine at discharge and one year later were collected and compared between patients on incremental PD or HD before Tx. Results. Seventeen patients on incremental PD and 24 on HD received their first renal Tx during the study period. Age, underlying nephropathy, RRF loss rate in predialysis, RRF at the start of RRT and comorbidity did not differ significantly. While on dialysis, patients on PD had significantly lower epoetin requirements, serum phosphate, calciumxphosphate product and better RRF preservation. Delayed graft function (DGF) occurred in 12 patients (29%), 1 on incremental PD and 11 on HD. Serum creatinine at discharge and 1 year later was significantly higher in patients who had been on HD. Conclusions. In patients receiving their first renal Tx, previous incremental PD was associated with low morbidity, excellent preservation of RRF, easier attainment of adequacy targets and significantly better immediate and 1-year graft function than those observed in otherwise well-matched patients previously treated with HD.

Changing Landscape for Peritoneal Dialysis: Optimizing Utilization

“…It has recently been suggested that an initial incremental approach to dialysis might help preserve residual renal function through an intact nephron hypothesis in reverse (35). Incremental PD can also be viewed as a bridge to either cadavericor living-related renal transplantation (36) with the potential for improved quality of life and less treatment burden due to the non-full-dose PD prescription (37). A significant reduction in loss of glomerular filtration rate in the incremental dialysis period vs. that which was observed in the predialysis period was also observed.…”

Incremental Hemodialysis Schedule in Patients with Higher Residual Renal Function at the Start of Dialysis

“…The rate of all-cause hospital admissions was 61% (25/41) and 88% (23/26), respectively ( = 0, 011). Hospitalization time was 4 (0-15) and 11 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) days/patient-years in the 2-and 3 HD/week groups, respectively (median and IQR, = 0, 068). Vascular access dysfunction was the cause of hospitalization in 6 patients of the group of 2 HD/week (15%) and in 8 patients of the group of 3 HD/week (31%) ( = 0, 071).…”

“…Dialysis dose in chronic patients treated with peritoneal dialysis is calculated using the sum of peritoneal clearance and residual renal function (RRF). Frequently, the peritoneal dialysis units start the treatment with a low peritoneal dose that is gradually increased afterwards to compensate the decline of RRF [1][2][3][4]. This incremental dialysis strategy is uncommon in hemodialysis units where it is habitual to start dialysis with the conventional thrice-weekly schedule (3 HD/week).…”

Work related characteristics, work-home and home-work interference and burnout among primary healthcare physicians: A gender perspective in a Serbian context

“…Only 1% of waged employment is part-time [ 9 ]. Home chores and childcare are still largely in women's hands, regardless of labour participation, education level or occupation [ 10 ]. Instead of obtaining help from the partner, Serbian women can be expected to receive help from a mother or a paid helper [ 11 ].…”