Incremental dialysis

The National Kidney Foundation-Dialysis Outcome Quality Initiative Peritoneal Dialysis Adequacy Clinical Practice Guideline 1 and Appendix A offered the first formal in-depth discussion of the concept of incremental dialysis (1). The context of the work group's concern was that it is paradoxical that we nephrologists have focused on optimizing urea clearance for end-stage renal disease patients, but not in pre-end-stage renal disease patients. Because so much evidence from the collective peritoneal dialysis experience suggested that a weekly Kt/Vurea of 2.0 is appropriate, the National Kidney Foundation-Dialysis Outcome Quality Initiative Peritoneal Dialysis Adequacy Work Group recommended that when the residual renal Kt/Vurea drops below 2.0, supplemental Kt/Vurea should be added incrementally by dialysis. This article describes this concept in more detail.