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Association of Incremental peritoneal dialysis with residual kidney function decline in patients on peritoneal
Ashik Hayat1,2,3, Yeoungjee Cho1,2,3, Carmel M Hawley1,2,3
1Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia.
Insights
Incremental peritoneal dialysis (PD) and full-dose PD strategies showed similar declines in residual kidney function (RKF) and urine volume (UV). This study compared these PD approaches to understand their impact on kidney function preservation in patients starting PD.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Peritoneal Dialysis
Background:
- Incremental peritoneal dialysis (PD), a less than full-dose prescription, may preserve residual kidney function (RKF), reduce glucose exposure, and lower peritonitis risk.
- Understanding the impact of incremental versus full-dose PD on RKF and urine volume (UV) is crucial for optimizing patient outcomes.
Purpose of the Study:
- To analyze the association between incremental and full-dose PD strategies and the decline in RKF and UV in patients initiating PD.
- To compare the effectiveness of different PD dosing strategies in preserving kidney function.
Main Methods:
- A randomized controlled trial (balANZ RCT) included incident PD patients with post-baseline RKF and UV measurements.
- Patients were classified as receiving incremental (<56 L/week) or full-dose (≥56 L/week) PD, with a sensitivity analysis using 42 L/week.
- Primary outcome was change in RKF; secondary outcome was change in daily UV.
Main Results:
- 154 patients (mean age 57.9 years) were analyzed, with 29.2% on incremental PD and 70.8% on full-dose PD.
- Both groups experienced significant declines in RKF and UV over 24 months (p < 0.001).
- No significant difference was observed in the rate of RKF decline (p = 0.78) or UV decline (p = 0.18) between incremental and full-dose PD groups.
Conclusions:
- Starting with incremental PD is associated with similar declines in RKF and UV compared to starting with full-dose PD.
- The choice between incremental and full-dose PD initiation does not appear to significantly impact the rate of kidney function loss or urine output decline in the short term.
Background:
Incremental peritoneal dialysis (PD), defined as less than Full-dose PD prescription, has several possible merits, including better preservation of residual kidney function (RKF), lower peritoneal glucose exposure and reduced risk of peritonitis. The aims of this study were to analyse the association of Incremental and Full-dose PD strategy with RKF and urine volume (UV) decline in patients commencing PD.
Methods:
Incident PD patients who participated in the balANZ randomised controlled trial (RCT) (2004-2010) and had at least one post-baseline RKF and UV measurement was included in this study. Patients receiving <56 L/week and ≥56 L/week of PD fluid at PD commencement were classified as Incremental and Full-dose PD, respectively. An alternative cut-point of 42 L/week was used in a sensitivity analysis. The primary and secondary outcomes were changes in measured RKF and daily UV, respectively.
Results:
The study included 154 patients (mean age 57.9 ± 14.1 years, 44% female, 34% diabetic, mean follow-up 19.5 ± 6.6 months). Incremental and Full-dose PD was commenced by 45 (29.2%) and 109 (70.8%) participants, respectively. RKF declined in the Incremental group from 7.9 ± 3.2 mL/min/1.73 m2 at baseline to 3.2 ± 2.9 mL/min/1.73 m2 at 24 months (p < 0.001), and in the Full-dose PD group from 7.3 ± 2.7 mL/min/1.73 m2 at baseline to 3.4 ± 2.8 mL/min/1.73 m2 at 24 months (p < 0.001). There was no difference in the slope of RKF decline between Incremental and Full-dose PD (p = 0.78). UV declined from 1.81 ± 0.73 L/day at baseline to 0.64 ± 0.63 L/day at 24 months in the Incremental PD group (p < 0.001) and from 1.38 ± 0.61 L/day to 0.71 ± 0.46 L/day in the Full-dose PD group (p < 0.001). There was no difference in the slope of UV decline between Incremental and Full-dose PD (p = 0.18).
Conclusions:
Compared with Full-dose PD start, Incremental PD start is associated with similar declines in RKF and UV.
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