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Incremental peritoneal dialysis: a 10 year single-centre experience.

Massimo Sandrini1, Valerio Vizzardi2, Francesca Valerio2

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Incremental peritoneal dialysis (incrPD) is a safe starting dialysis method. Compared to standard PD (stPD), incrPD offers similar survival, fewer hospitalizations, and preserves renal function longer.

Keywords:
Dialysis adequacyIncremental dialysisPeritoneal dialysisResidual renal function

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Area of Science:

  • Nephrology
  • Renal Replacement Therapy
  • Dialysis Techniques

Background:

  • Incremental dialysis aims to maintain solute clearance near guideline targets.
  • Incremental peritoneal dialysis (incrPD) involves 1-2 daily dwell times, contrasting with standard PD (stPD)'s 3-4 dwell times.

Purpose of the Study:

  • To evaluate the safety and efficacy of incremental peritoneal dialysis (incrPD) as an initial dialysis modality.
  • To compare incrPD with standard peritoneal dialysis (stPD) in terms of patient survival, renal function, and complications.

Main Methods:

  • A single-centre cohort study enrolled incident patients with residual renal function (RRF) of 3-10 ml/min/1.73 sqm BSA requiring PD.
  • Follow-up extended to December 2012, with a median incrPD duration of 17 months.
  • Compared clinical characteristics, adequacy, peritonitis-free survival, patient survival, and hospitalization rates between incrPD and stPD groups.

Main Results:

  • No significant differences in clinical characteristics, adequacy, or patient survival between incrPD (n=29) and stPD (n=76) groups.
  • Residual renal function (RRF) remained stable in incrPD during the first 6 months, unlike in stPD where it decreased (p<0.001).
  • incrPD patients had significantly lower hospitalization rates (p=0.021) and a trend towards lower peritonitis incidence.

Conclusions:

  • Incremental peritoneal dialysis (incrPD) is a safe and effective initial dialysis modality.
  • incrPD demonstrates comparable survival rates to stPD, with added benefits of reduced hospitalizations and slower decline in renal function.
  • A notable proportion of incrPD patients (8/29) received a kidney transplant before requiring full-dose dialysis.