Patients With Nonfast Peritoneal Transfer Rate are More Suitable for Incremental Peritoneal Dialysis

Previous studies have shown that incremental peritoneal dialysis (iPD) improves the prognosis of patients on PD with tolerable residual kidney function (RKF). The peritoneal solute transfer rate (PSTR) characterizes peritoneal ultrafiltration and solute transfer. However, the most appropriate recipients of iPD have not been identified. Therefore, we hypothesized that patients with different PSTRs would experience different clinical benefits of iPD therapy.

We studied patients with RKF who initiated continuous ambulatory peritoneal dialysis (CAPD) at our center. The enrolled patients were allocated to fast and nonfast PSTR groups, and then to iPD or full-dose PD. To mitigate the influence of confounding factors, propensity score matching was employed. The clinical outcomes associated with iPD and full-dose PD in the fast and nonfast PSTR groups were compared.

A total of 974 patients on CAPD were enrolled. The median duration of maintenance using iPD for the nonfast PSTR group was longer than that for the fast PSTR group (21.0 vs. 15.6 months, P=0.011). Patients in nonfast PSTR group who underwent iPD had lower risks of mortality [hazard ratio (HR) 0.25, P=0.002], anuria (HR 0.53, P=0.003), and cardiovascular (CV) mortality (HR 0.36, P=0.047) than those who underwent full-dose PD after matching. However, these clinical benefits of iPD therapy were not present in the fast PSTR group.

Patients who show nonfast PSTR maintain iPD longer and experience superior clinical benefits compared with those who undergo fast PSTR. Therefore, patients who experience nonfast PSTR may be more suitable for iPD therapy than those who experience fast PSTR.