The Use of Incremental Peritoneal Dialysis in a Large Contemporary Peritoneal Dialysis Program

Abstract

Background:The use of an incremental peritoneal dialysis (PD) strategy in a large contemporary patient population has not been described.Objective:We report the use of this strategy in clinical practice, the prescriptions required, and the clearances achieved in a large center which has routinely used this approach for more than 10 years.Design:This is a cross-sectional observational study.Setting:A single large Canadian academic center.Patients:This study collected data on 124 prevalent PD patients at a single Canadian academic center.Methods and Measurements:The proportion of patients who achieve the clearance target on a low clearance or incremental PD prescription; the actual PD prescriptions and consequent total, peritoneal, and renal urea clearances [Kt/V] achieved; and patient and technique survival and peritonitis rate in comparison with national and international reports.Results:Of the 124 prevalent PD patients in this PD unit, 106 (86%) were achieving the Kt/V target, and of these, 54 (44% of all patients) were doing so using incremental PD prescriptions. Fifty of these incremental PD patients were using automated PD (APD) with either no day dwell (68%) or less than 7 days a week treatment (12%) or both (20%). Patient survival in our PD unit was not different from that reported in Canada as a whole. Peritonitis rates were better than internationally recommended standards.Limitations:This is an observational study with no randomized control group.Conclusions:Incremental PD is feasible in a contemporary PD population treated mainly with APD. Almost half of the patients were able to achieve clearance targets while receiving less onerous and less costly low clearance prescriptions. We suggest that incremental PD should be widely used as a cost-effective strategy in PD.

Global Dialysis Perspective: Canada

“…Clearance targets drive PD prescription practices but less so than in HD. Incremental strategies are increasingly used (17). Icodextrin is widely used, but normal pH "biocompatible" solutions are not, partly due to higher cost and uncertain evidence.…”

End-Stage Kidney Disease in Patients With Autosomal Dominant Polycystic Kidney Disease: A 12-Year Study Based on the Canadian Organ Replacement Registry

“…In an attempt to retain residual renal function, incremental PD may be a viable option. 32 Last, several studies have reported that survival and long-term therapy outcomes of ADPKD patients on PD did not differ significantly against matched non-ADPKD controls, 33 , 34 with 1 study reporting a notably high survival rate. 34 This was consistent with our findings that ADPKD patients with PD as an initial therapy demonstrated improved survival compared with non-ADPKD patients.…”

Conventional dialysis in the elderly: How lenient should our guidelines be?

“…Indeed, there is one observational study reporting that for an elderly cohort, there are less frequent episodes of hospitalization with twice‐weekly hemodialysis . Similar approaches in peritoneal dialysis, using days‐off and/or a reduced number of exchanges have also been shown to deliver adequate Kt/V, do not appear to be associated with worse mortality and may be associated with lower hospitalization rates …”

“…48 Similar approaches in peritoneal dialysis, using days-off and/or a reduced number of exchanges have also been shown to deliver adequate Kt/V, do not appear to be associated with worse mortality and may be associated with lower hospitalization rates. 49,50 The use of incremental dialysis and the associated reduction in dialysis burden enabled by residual renal function is likely to improve patient experience and therefore patient outcomes. Preservation of residual renal function should therefore be incorporated into guidelines for dialysis delivery in older people.…”