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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.
Seminars in Dialysis
|May 29, 2018
Summary
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.
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