Preliminary Evaluation of Incremental Peritoneal Dialysis in 25 Patients

Abstract

Background Incremental dialysis has been suggested for patients with some residual renal function. However, very little published clinical data exist on the feasibility of this schedule. Objectives To assess feasibility of incremental dialysis, with regard to its effect, complications, and impact on quality of life. Design Pilot prospective study, not controlled. Setting Nephrology division, public clinical research hospital. Patients Twenty-five patients (19 men, mean age 61 ± 13 years, body weight 63 ± 11 kg) began peritoneal dialysis (the first treatment of uremia) with a single nightly exchange lasting 10 hours or 2 daily exchanges over 12 hours according to creatinine clearance and Kt/V. Patients gave informed consent and reported their work activity, degree of rehabilitation, and their quality of life by answering a questionnaire prepared for this purpose. Outcome Measures Survival rate, complications related to peritoneal dialysis, and residual renal and peritoneal clearances. Results During the study period no patient died. Complications related to dialysis were peritonitis (0.41 episodes/year) and exit-site infection (0.32 episodes/year). All patients continued to work with full rehabilitation and considered 1 or 2 exchanges per day less troublesome than 3 or 4. Conclusions Incremental dialysis is well accepted by patients and staff. This technique does not involve a high risk of complications and is economical. Therefore incremental dialysis is feasible.

Number of Daily Peritoneal Dialysis Exchanges and Mortality Risk in a Chinese Population

“…In economically advanced countries, < 4 dextrose exchanges per day is a prescription most often seen in those patients who are starting dialysis, administered as an incremental prescription that increases over time (68)(69)(70)(71). Observational evidence suggests that incremental PD can provide adequate dialysis in those with sufficient residual kidney function (72)(73)(74)(75). Cumulative clinical experience with this approach is increasing (76,77), as both a means of achieving better outcomes and also managing constrained resources (78,79).…”

Therapeutic Challenges to End-Stage Kidney Disease in a Patient with Tetralogy of Fallot

“… 4 , 34 , 35 PD with reduced dialysate exchanges may be less advantageous than full-dose PD in terms of ultrafiltration and dialytic clearance, while such a PD protocol may permit early incremental dialysis and provide favorable clinical significance. 33 , 36 , 37 At present, our patient appears to tolerate the PD program well with two daily dialysate exchanges; however, the validity of our strategy should be determined only when more experience with additional cases similar to ours has been accumulated. Thus, the establishment of an optimal management program for end-stage kidney disease patients with congenital heart disease should be a matter requiring continuous and careful attention.…”

Incremental Peritoneal Dialysis: A Non-Marginal Treatment, Qualitatively and Quantitatively

“…Il mutamento della popolazione dialitica che si è progressivamente verificato negli ultimi anni ha posto ai Nefrologi nuove e diverse sfide in scenari via via più complessi. La DP può essere avviata con uno schema di dialisi incrementale (DPI), che permette un trattamento con una dose dialitica bassa, che viene poi modificata nel tempo al deterioramento della funzione renale residua (1). Non vi è accordo su quando iniziare la terapia sostitutiva, e le Linee Guida lasciano allo specialista la valutazione dei rischi e dei benefici (2)…”