Incremental Peritoneal Dialysis May be Beneficial for Preserving Residual Renal Function Compared to Full-dose Peritoneal Dialysis

Abstract

Maintaining residual renal function (RRF) is a crucial issue in peritoneal dialysis (PD). Incremental dialysis is the practice of initiating PD exchanges less than four times a day in consideration of RRF, and increasing dialysis dose in a step-wise manner as the RRF decreases. We aimed to compare the outcomes of incremental PD and full-dose PD in terms of RRF preservation and other outcomes. This was a single-center, observational study. Data were extracted retrospectively from a cohort of incident PD patients over 16 years old who started PD between 2007 and 2015 in the PD Unit of Seoul National University Hospital. We used inverse probability weighting (IPW) adjustment based on propensity scores to balance covariates between the incremental and full-dose PD groups. Multivariate, time-dependent Cox analyses were performed. Among 347 incident PD patients, 176 underwent incremental PD and 171 underwent conventional full-dose PD. After IPW adjustment, the incremental PD group exhibited a lower risk of developing anuria (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.43–0.88). Patient survival, technique survival, and peritonitis-free survival were all similar between these groups ( P > 0.05 by log-rank test). Incremental PD was beneficial for preserving RRF and showed similar patient survival when compared to conventional full-dose PD.

Comparison of clinical outcome between incremental peritoneal dialysis and conventional peritoneal dialysis: a propensity score matching study

“…Sandrini et al showed that patients with iPD had similar survival rates, lower hospitalization, a trend toward lower peritonitis incidence and slower reduction of renal function compared to cPD [13]. Lee et al reported that iPD was beneficial for preserving RRF, even with similar technique for survival and mortality rates in comparison with cPD [14]. Still, there are no data about demonstrating the survival benefits caused by iPD in patients with DM.…”

“…A possible mechanism of iPD benefit may be less exposure of the glucose PD solution caused by fewer exchanging PD solutions. Numerous studies have compared iPD and cPD [13][14][15][16], but there were no reports that would compare iPD and cPD in a diabetic population treated with PD. The results of this study showed that clinical benefits of iPD were prominent in diabetic patients.…”

Protection of Residual Renal Function and Nutritional Treatment: First Step Strategy for Reduction of Uremic Toxins in End-Stage Kidney Disease Patients

“…Moreover, an incremental approach to dialysis seems to slow down the loss of RKF in respect to full dialysis dose, probably thanks to the lower hemodynamical impact and hypoperfusion challenge on residual nephrons when low ultrafiltration rates are required. This is also true for incremental peritoneal dialysis programs, as shown by Sandrini et al [44] and by Lee et al [45]. In the clinical course of a patient with CKD, the stage 5 is characterized by very poor kidney function, and hence, by the maximum chance of toxins retention; thus, particular attention should be paid to the timing and the type of dialysis during the transition phase.…”

Setting Up and Expanding a Home Dialysis Program: Is There a Recipe for Success?

“…One strategy we follow at UAB to reduce burden of disease includes incremental PD which allows patients to have reduced number of days, fill volume, or exchanges as long as the total PD clearance remains adequate. Incremental PD may preserve residual renal function and improve quality of life for patients, without any effect on mortality or technique failure (41,42). In addition, to keep the burden of clinic visits and transportation low, we offer patients the ability to make only one clinic visit per month for their laboratory draws and the physician visit; they are called a week later with their test results by one of the team members, and abnormal laboratory results and interventions are discussed on the phone.…”