Incremental Versus Standard (Full-Dose) Peritoneal Dialysis

Nataatmadja, Melissa; Cho, Yeoungjee; Krishnasamy, Rathika; Jain, Arsh K.; Boudville, Neil; Johnson, David W.; Huang, Louis

doi:10.1016/j.ekir.2021.11.019

Cited by 24 publications

(24 citation statements)

References 69 publications

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“…Since many refractory CHF patients starting PD for fluid removal have substantial residual renal function incremental dialysis may be used. Incremental PD is defined as less than “standard dose” PD prescription [ 81 ]. There are many potential advantages of incremental PD, including reduced peritonitis risk, lower peritoneal glucose exposure and cost, preservation of residual renal function, and improved quality of life [ 81 ].…”

Section: Peritoneal Dialysis In Congestive Heart Failurementioning

confidence: 99%

“…Incremental PD is defined as less than “standard dose” PD prescription [ 81 ]. There are many potential advantages of incremental PD, including reduced peritonitis risk, lower peritoneal glucose exposure and cost, preservation of residual renal function, and improved quality of life [ 81 ]. PD dose is increased as needed if and when residual renal function declines.…”

Section: Peritoneal Dialysis In Congestive Heart Failurementioning

confidence: 99%

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The Peritoneal Membrane—A Potential Mediator of Fibrosis and Inflammation among Heart Failure Patients on Peritoneal Dialysis

Kunin

Beckerman

2022

Membranes

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Peritoneal dialysis is a feasible, cost-effective, home-based treatment of renal replacement therapy, based on the dialytic properties of the peritoneal membrane. As compared with hemodialysis, peritoneal dialysis is cheaper, survival rate is similar, residual kidney function is better preserved, fluid and solutes are removed more gradually and continuously leading to minimal impact on hemodynamics, and risks related to a vascular access are avoided. Those features of peritoneal dialysis are useful to treat refractory congestive heart failure patients with fluid overload. It was shown that in such patients, peritoneal dialysis improves functional status and quality of life, reduces hospitalization rate, and may decrease mortality rate. High levels of serum proinflammatory cytokines and fibrosis markers, among other factors, play an important part in congestive heart failure pathogenesis and progression. We demonstrated that those levels decreased following peritoneal dialysis treatment in refractory congestive heart failure patients. The exact mechanism of beneficial effect of peritoneal dialysis in refractory congestive heart failure is currently unknown. Maintenance of fluid balance, leading to resetting of neurohumoral activation towards a more physiological condition, reduced remodeling due to the decrease in mechanical pressure on the heart, decreased inflammatory cytokine levels and oxidative stress, and a potential impact on uremic toxins could play a role in this regard. In this paper, we describe the unique characteristics of the peritoneal membrane, principals of peritoneal dialysis and its role in heart failure patients.

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Section: Peritoneal Dialysis In Congestive Heart Failurementioning

confidence: 99%

Section: Peritoneal Dialysis In Congestive Heart Failurementioning

confidence: 99%

The Peritoneal Membrane—A Potential Mediator of Fibrosis and Inflammation among Heart Failure Patients on Peritoneal Dialysis

Kunin

Beckerman

2022

Membranes

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“…En outre, la dialyse péritonéale permet facilement une prescription adaptée au patient et une dialyse incrémentale -la dialyse péritonéale incrémentale présente plusieurs avantages documentés, notamment la préservation de la fonction rénale résiduelle, la réduction du risque de péritonite, une moindre exposition au glucose, une meilleure protection de l'environnement et une réduction des coûts [28].…”

Section: Préparation à La Dialyse : Tendon D'achille Ou Opportunité E...unclassified

Managing Transition between dialysis modalities: a call for Integrated care In Dialysis Units

Dias

Rodrigues

2022

Bull Dial Domic

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Summary Patients with chronic kidney disease have three main possible groups of dialysis techniques: in-center hemodialysis, peritoneal dialysis, and home hemodialysis. Home dialysis techniques have been associated with clinical outcomes that are equivalent and sometimes superior to those of in-center hemodialysisTransitions between treatment modalities are crucial moments. Transition periods are known as periods of disruption in the patient’s life associated with major complications, greater vulnerability, greater mortality, and direct implications for quality of life. Currently, it is imperative to offer a personalized treatment adapted to the patient and adjusted over time.An integrated treatment unit with all dialysis treatments and a multidisciplinary team can improve results by establishing a life plan, promoting health education, medical and psychosocial stabilization, and the reinforcement of health self-care. These units will result in gains for the patient’s journey and will encourage home treatments and better transitions.Peritoneal dialysis as the initial treatment modality seems appropriate for many reasons and the limitations of the technique are largely overcome by the advantages (namely autonomy, preservation of veins, and preservation of residual renal function).The transition after peritoneal dialysis can (and should) be carried out with the primacy of home treatments. Assisted dialysis must be considered and countries must organize themselves to provide an assisted dialysis program with paid caregivers.The anticipation of the transition is essential to improve outcomes, although there are no predictive models that have high accuracy; this is particularly important in the transition to hemodialysis (at home or in-center) in order to plan autologous access that allows a smooth transition.

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“…Despite current guidelines supporting the choice of an incremental approach for HD prescription, the vast majority of ESKD patients still begin on a TW-HD regimen in resource-rich countries [ 6 , 8 , 9 ]. Although not universal, incremental prescription considering RKF is more commonly accepted in peritoneal dialysis (PD) [ 10 ]. Moreover, PD has also been associated with better RKF preservation as compared with TW-HD in observational reports [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of incident patients treated with incremental haemodialysis as compared with standard haemodialysis and peritoneal dialysis

Jaques

Ponte

Haidar

et al. 2022

Nephrology Dialysis Transplantation

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Background Residual kidney function is considered better preserved with incremental haemodialysis (I-HD) or peritoneal dialysis (PD) as compared with conventional thrice-weekly HD (TW-HD) and is associated with improved survival. We aimed to describe outcomes of patients initiating dialysis with I-HD, TW-HD or PD. Methods We conducted a retrospective analysis of a prospectively assembled cohort in a single university centre including all adults initiating dialysis from January 2013 to December 2020. Primary and secondary endpoints were overall survival and hospitalization days at 1 year, respectively. Results We included 313 patients with 234 starting on HD (166 TW-HD and 68 I-HD) and 79 on PD. At the end of the study, 10 were still on I-HD while 45 transitioned to TW-HD after a mean duration of 9.8 ± 9.1 months. Patients who stayed on I-HD were less frequently diabetics (P = .007). Mean follow-up was 33.1 ± 30.8 months during which 124 (39.6%) patients died. Compared with patients on TW-HD, those on I-HD had improved survival (hazard ratio 0.49, 95% confidence interval 0.26-0.93, P = .029), while those on PD had similar survival. Initial kidney replacement therapy modality was not significantly associated with hospitalization days at 1 year. Conclusions I-HD is suitable for selected patients starting dialysis and can be maintained for a significant amount of time before transition to TW-HD, with diabetes being a risk factor. Although hospitalization days at 1 year are similar, initiation with I-HD is associated with improved survival as compared with TW-HD or PD. Results of randomized controlled trials are awaited prior to large-scale implementation of I-HD programmes.

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Incremental Versus Standard (Full-Dose) Peritoneal Dialysis

Cited by 24 publications

References 69 publications

The Peritoneal Membrane—A Potential Mediator of Fibrosis and Inflammation among Heart Failure Patients on Peritoneal Dialysis

The Peritoneal Membrane—A Potential Mediator of Fibrosis and Inflammation among Heart Failure Patients on Peritoneal Dialysis

Managing Transition between dialysis modalities: a call for Integrated care In Dialysis Units

Outcomes of incident patients treated with incremental haemodialysis as compared with standard haemodialysis and peritoneal dialysis

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