Intermittent peritoneal dialysis (IPD): an old but still effective modality for severely disabled ESRD patients

Hospital-based intermittent peritoneal dialysis (IPD) is an old PD modality applied for as long as 40 h per week using high volumes of PD fluid, but it has almost been abandoned due to its low solute clearances. However, IPD might be the only option for elderly dialysis patients with significant comorbidities, unable to undergo haemodialysis (HD) or PD at home without any assistance, for various reasons.

We describe our experience with 25 patients aged 71.2 +/- 7.5 years with a previous history of HD for 55.4 +/- 54 months, dialysed with IPD for more than 3 months. IPD was performed three times weekly for 8-10 h.

Mean values for haematocrit, serum urea, creatinine, sodium, potassium and calcium were comparable with other ESRD populations, whereas there were significantly lower values for albumin (3.2 +/- 0.3 mg/dL) and significantly higher values for phosphorus (7.1 +/- 1.7 mg/dL) despite the use of phosphate binders. The patients survived for a mean of 16.8 +/- 11.5 (3-43) months despite very low solute clearances, as expressed by Kt/V urea (1 +/- 0.26) and weekly creatinine clearance (27.2 +/- 7.6 L/week). However, by using 22.9 +/- 4.5 L of various combinations of isotonic and hypertonic PD fluids, the mean ultrafiltrate was 1854 +/- 326 mL per session. There were only two cases of peritonitis, unrelated to IPD per se.

Considering the underlying comorbidities, IPD remains a valuable and effective option with acceptable survival rates, for a special population of ESRD patients not able for various reasons to undergo HD, neither PD at home.