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Incremental peritoneal dialysis: New ideas about an old approach
Bourne L Auguste1, Joanne M Bargman1
1Division of Nephrology, University Health Network, Toronto, ON, Canada.
Insights
Transitioning to dialysis is difficult. Focusing on clinical criteria over Kt/Vurea targets for incremental peritoneal dialysis (PD) may improve patient quality of life and treatment acceptance.
Area of Science:
- Nephrology
- Renal Replacement Therapy
Background:
- The transition to dialysis for end-stage kidney disease (ESKD) presents significant challenges for patients and care partners.
- Incremental dialysis strategies, focusing on clinical outcomes, offer improved quality of life and cost-effectiveness compared to traditional approaches.
- Incremental hemodialysis (HD) has shifted towards clinical criteria, moving away from prespecified Kt/Vurea targets.
Discussion:
- Incremental peritoneal dialysis (PD) traditionally relies on achieving specific Kt/Vurea values by summing residual renal and peritoneal clearances.
- A new approach to incremental PD, mirroring incremental HD, could eliminate Kt/Vurea targets and prioritize clinical assessment.
- This shift may reduce patient disruption and enhance treatment acceptance, focusing on holistic patient well-being.
Key Insights:
- Shifting incremental PD from Kt/Vurea targets to clinical criteria may enhance patient acceptance and reduce treatment disruption.
- Adopting a clinical criteria-based approach for incremental PD aligns with recent trends in incremental HD.
- Focusing on clinical assessment rather than solely on small solute kinetics promotes a more patient-centered care model.
Outlook:
- Future research should explore the clinical outcomes and patient-reported benefits of incremental PD based on clinical criteria.
- This new approach has the potential to redefine incremental PD, making it more adaptable and patient-friendly.
- Further investigation into holistic clinical assessment in PD could lead to optimized treatment strategies for ESKD patients.
Abstract:
Coping with the transition from end-stage kidney disease to dialysis can be challenging for patients and their care partners. Introducing incident dialysis patients to incremental forms of dialysis is associated with better quality of life and reduced cost. Incremental hemodialysis (HD) has generated significant interest over the last decade with treatments that focus on clinical criteria rather than prespecified Kt/Vurea targets. Incremental peritoneal dialysis (PD) has traditionally focused on the sum of residual renal and peritoneal clearances to achieve a specific Kt/Vurea value. Gradual increases in the PD dose were prescribed as the residual kidney function declined. Adopting a new approach to incremental PD similar to what has been done for incremental HD would obviate the need for Kt/Vurea and focus exclusively on clinical criteria. New incremental PD may be considered less disruptive to incident dialysis patients, and may be more likely to be accepted as treatment. It will also reduce our obsession with small solute kinetics and enhance encounters with patients by focusing instead on the holisitc clinical assessment.
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