Incremental peritoneal dialysis.

Area of Science:

• Nephrology
• Renal Replacement Therapy

Background:

• Residual renal function is often present at dialysis initiation.
• Standard peritoneal dialysis (PD) dosing may not fully leverage this residual function.
• Defining incremental PD is crucial for optimizing treatment strategies.

Purpose of the Study:

• To define incremental peritoneal dialysis (PD) as a strategic approach rather than a fixed regimen.
• To highlight the benefits of utilizing residual renal function in early PD treatment.
• To advocate for the adoption of incremental PD based on current evidence.

Main Methods:

• Proposed definition of incremental PD as a strategy.
• Initial PD dose is less than standard, accounting for residual renal function.
• Peritoneal clearance is initially below goal, but combined renal and peritoneal clearance meets the goal.
• Clear plan to increase PD dose as renal function declines.

Main Results:

• Incremental PD lessens dialysis workload, reduces costs, and minimizes peritoneal membrane exposure to glucose.
• May decrease mechanical symptoms associated with PD.
• Evidence suggests clinical outcomes are comparable to full-dose PD, despite lack of definitive large trials.

Conclusions:

• Incremental PD is a cost-effective and less burdensome strategy.
• It is a reasonable approach given current evidence, supporting its adoption.
• Further large randomized trials are needed to definitively confirm superior outcomes.