Incremental peritoneal dialysis preserves residual renal function in diabetic end-stage kidney disease

This retrospective cohort study investigated the association between incremental peritoneal dialysis (iPD) and clinical outcomes in 76 diabetic patients with end-stage kidney disease who initiated peritoneal dialysis (PD) between 2013 and 2023. All participants had baseline residual renal function (RRF) ≥3 mL/min/1.73 m². The median age was 67 years, and 71.1% were male. During a median follow-up of 40 months, 44 patients (57.9%) received iPD; 23 (30.3%) lost RRF, 14 (18.4%) transferred to hemodialysis, and 39 (51.3%) died, including 18 (23.7%) from cardiovascular causes. Compared with full-dose PD, iPD was associated with a significantly lower risk of RRF loss in multivariable Cox regression (HR = 0.385, p = 0.027) and Fine-Gray competing risk analysis (sHR = 0.384, p = 0.029), without increasing the risks of transfer to hemodialysis or mortality. Elevated baseline log-transformed NT-proBNP independently predicted RRF loss (HR = 4.687, p = 0.005). Advanced age independently predicted mortality (HR = 1.087 [per years of age], p < 0.001), while elevated HbA1c independently predicted both all-cause (HR = 1.641 [per 1% HbA1c], p = 0.002) and cardiovascular mortality (sHR = 2.175 [per 1% HbA1c], p = 0.002). These findings suggest that iPD is a safe initial strategy that better preserves RRF in diabetic patients with baseline RRF ≥3 mL/min/1.73 m², and optimal glycemic control is crucial for improving long-term outcomes in this high-risk population.