Incremental Peritoneal Dialysis May be Beneficial for Preserving Residual Renal Function Compared to Full-dose Peritoneal Dialysis

Lee, Yeonhee; Chung, Siu-Wah; Park, Seokwoo; Ryu, Hyunjin; Kim, Yon Su; Joo, Kwon Wook; Ahn, Curie; Lee, Joongyub; Oh, Kook Hwan

doi:10.1038/s41598-019-46654-2

Cited by 32 publications

(43 citation statements)

References 38 publications

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“…Sandrini et al showed that patients with iPD had similar survival rates, lower hospitalization, a trend toward lower peritonitis incidence and slower reduction of renal function compared to cPD [13]. Lee et al reported that iPD was beneficial for preserving RRF, even with similar technique for survival and mortality rates in comparison with cPD [14]. Still, there are no data about demonstrating the survival benefits caused by iPD in patients with DM.…”

Section: Discussionmentioning

confidence: 99%

“…A possible mechanism of iPD benefit may be less exposure of the glucose PD solution caused by fewer exchanging PD solutions. Numerous studies have compared iPD and cPD [13][14][15][16], but there were no reports that would compare iPD and cPD in a diabetic population treated with PD. The results of this study showed that clinical benefits of iPD were prominent in diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of clinical outcome between incremental peritoneal dialysis and conventional peritoneal dialysis: a propensity score matching study

et al. 2021

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Background: Incremental peritoneal dialysis (iPD) can be useful in patients with residual renal function (RRF). RRF was well preserved and similar survival was shown in iPD compared to conventional PD (cPD) in previous study. However, the long-term survival of iPD remains unclear compared to cPD in diabetic patients. This study evaluated whether patient survival, hospitalization and peritonitis, and PD survival in iPD were lower than cPD or not. Methods: We conducted a 12-year retrospective observational study of 303 PD patients (232 cPD and 71 iPD) using propensity score matching by age, gender, and diabetes mellitus (DM). Finally, 78 cPD patients and 39 iPD patients were included and 44 patients had DM. Incremental PD was defined as starting PD with two or three manual exchanges per day. Results: The median duration of iPD was 24.1 months and iPD had higher RRF than cPD. Compared to cPD, the patient survival, PD survival and hospitalization benefits were not found in iPD but diabetic iPD patients had significantly longer survival and less hospitalization. Cumulative risk for peritonitis was lower iPD and PD duration of iPD was longer than those of cPD. The iPD was an independent factor associated with survival in patients with DM. Conclusions: Incremental PD may be a safe PD modality to initiate and maintain PD in less uremic patients with tolerable RRF. Incremental PD would be a benefit for survival in diabetic patients. Further prospective studies are necessary to confirm the effectiveness of iPD in PD patients with similar RRF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of clinical outcome between incremental peritoneal dialysis and conventional peritoneal dialysis: a propensity score matching study

et al. 2021

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“…Moreover, an incremental approach to dialysis seems to slow down the loss of RKF in respect to full dialysis dose, probably thanks to the lower hemodynamical impact and hypoperfusion challenge on residual nephrons when low ultrafiltration rates are required. This is also true for incremental peritoneal dialysis programs, as shown by Sandrini et al [44] and by Lee et al [45]. In the clinical course of a patient with CKD, the stage 5 is characterized by very poor kidney function, and hence, by the maximum chance of toxins retention; thus, particular attention should be paid to the timing and the type of dialysis during the transition phase.…”

Section: Protection Of Residual Kidney Functionmentioning

confidence: 93%

Protection of Residual Renal Function and Nutritional Treatment: First Step Strategy for Reduction of Uremic Toxins in End-Stage Kidney Disease Patients

Cupisti

Bolasco

Giannese

et al. 2021

Toxins

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The retention of uremic toxins and their pathological effects occurs in the advanced phases of chronic kidney disease (CKD), mainly in stage 5, when the implementation of conventional thrice-weekly hemodialysis is the prevalent and life-saving treatment. However, the start of hemodialysis is associated with both an acceleration of the loss of residual kidney function (RKF) and the shift to an increased intake of proteins, which are precursors of uremic toxins. In this phase, hemodialysis treatment is the only way to remove toxins from the body, but it can be largely inefficient in the case of high molecular weight and/or protein-bound molecules. Instead, even very low levels of RKF are crucial for uremic toxins excretion, which in most cases are protein-derived waste products generated by the intestinal microbiota. Protection of RKF can be obtained even in patients with end-stage kidney disease (ESKD) by a gradual and soft shift to kidney replacement therapy (KRT), for example by combining a once-a-week hemodialysis program with a low or very low-protein diet on the extra-dialysis days. This approach could represent a tailored strategy aimed at limiting the retention of both inorganic and organic toxins. In this paper, we discuss the combination of upstream (i.e., reduced production) and downstream (i.e., increased removal) strategies to reduce the concentration of uremic toxins in patients with ESKD during the transition phase from pure conservative management to full hemodialysis treatment.

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“…One strategy we follow at UAB to reduce burden of disease includes incremental PD which allows patients to have reduced number of days, fill volume, or exchanges as long as the total PD clearance remains adequate. Incremental PD may preserve residual renal function and improve quality of life for patients, without any effect on mortality or technique failure (41,42). In addition, to keep the burden of clinic visits and transportation low, we offer patients the ability to make only one clinic visit per month for their laboratory draws and the physician visit; they are called a week later with their test results by one of the team members, and abnormal laboratory results and interventions are discussed on the phone.…”

Section: Decreasing Attritionmentioning

confidence: 99%

Setting Up and Expanding a Home Dialysis Program: Is There a Recipe for Success?

2020

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Home dialysis modalities remain significantly underused in the United States despite similar overall survival in the modalities, and recent incentives to expand these modalities. Although the absolute number of patients using home modalities has grown, the proportion compared to in-center hemodialysis (ICHD) continues to remain quite low. Well known barriers to home dialysis utilization exist, and an organized and team-based approach is required to overcome these barriers. Herein, we describe our efforts at growing our home dialysis program at a large academic medical center, with the proportion of home dialysis patients growing from 12% to 21% over the past 9 years. We prioritized individualized education for patients and better training for physicians, with the help of existing resources, aimed at better utilization of home modalities; an example includes dedicated dialysis education classes taught twice monthly by an experienced nurse practitioner, as well as the utilization of the dialysis educator from a dialysis provider for inpatient education of patients with CKD. The nephrology fellowship curriculum was restructured with emphasis on home modalities, and participation in annual home dialysis conferences has been encouraged. For timely placement and troubleshooting of access for dialysis, we followed a complementary team approach using surgeons and interventional radiologists and nephrologists, driven by a standardized protocol developed at UAB, and comanaged by our access coordinators. A team-based approach, with emphasis on staff engagement and leadership opportunities for dialysis nurses as well as collaborative efforts from a team of clinical nephrologists and the dialysis provider helped maintain efficiency, kindle growth, and provide consistently high-quality clinical care in the home program. Lastly, efforts at reducing burden of disease such as decreased number of monthly visits as well as using innovative strategies, such as telenephrology and assisted PD and HHD, were instrumental in reducing attrition.

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Incremental Peritoneal Dialysis May be Beneficial for Preserving Residual Renal Function Compared to Full-dose Peritoneal Dialysis

Cited by 32 publications

References 38 publications

Comparison of clinical outcome between incremental peritoneal dialysis and conventional peritoneal dialysis: a propensity score matching study

Comparison of clinical outcome between incremental peritoneal dialysis and conventional peritoneal dialysis: a propensity score matching study

Protection of Residual Renal Function and Nutritional Treatment: First Step Strategy for Reduction of Uremic Toxins in End-Stage Kidney Disease Patients

Setting Up and Expanding a Home Dialysis Program: Is There a Recipe for Success?

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