Start Dialysis With Incremental PD
The majority of patients starting dialysis have residual kidney function (RKF) making them suitable for Incremental PD.
“Incremental peritoneal dialysis (IPD) is a strategy by which less than standard “full-dose” PD is prescribed in people initiating PD so that the combination of residual renal and peritoneal clearance achieved is sufficient to achieve individualized clearance goals; it is done with the intention of increasing the peritoneal prescription if and when residual renal clearance subsequently declines”.1
- Most patients start IPD with a GFR in the range of 5-12 mL/min/1.73 m2 when moderate uremic symptoms present*2,3
- Patients are monitored for residual GFR using averages of creatinine and urea clearance3,4
- The dialysis dose may be gradually increased over time to compensate for any decline in renal function and meet adequacy targets3,4
Incremental PD Offers Many Benefits
RKF is associated with better patient survival
80% of patients survive anuria-free 2+ years longer with incremental PD4
IPD May Preserve Kidney Function Better Than Full-dose PD without Increasing Risk of Peritonitis4
Overall median time to the first peritonitis event was 2.3 years for patients on Incremental PD and full dose4
Study design: A retrospective, randomized study (n=347 patients) between 2007-2015, comparing patients on incremental PD and full dose PD. Primary outcome in the study was anuria-free survival comparing IPD and full dose PD. Inversed probability weighted, adjusted anuria-free survival using time-dependent Cox proportional hazards model. This was an observational, single-center study, which included only CAPD patients with >200mL daily urine volume.
Lower hospitalization
- Maintain individual's quality of life
- Enable them to meet their life goals
- Minimize symptoms and treatment burden
- Ensure delivery of high-quality care
Ease the Transition of Dialysis for Patients
Incremental PD may provide an option for a smoother transition to dialysis
- Less burden for patient and carers (with fewer exchanges or dialysis-free days)
- Less time spent doing dialysis and more time for normal life activities and goals
- Reduced amount of dialysis fluid normalizes living environment
- Less storage space required
- Less waste and improved environmental impact
- Symptom burden reduced
- Incremental PD clears solutes and achieves adequate dialysis.
- Patients feel able to achieve life goals.
- Maintains independence
We could also add other benefits here and to the table above:
Extends time on PD
Navaratnarajah Perit Dial Int 2021
- Tailoring the PD prescription to RKF enables days off dialysis and reduces therapy burden
- There was a strong association of the use of this flexible prescription with longer stay on PD
Multivariate analysis suggested that the incremental approach was associated with a significantly reduced chance of transfer to hemodialysis
Study design: A retrospective, randomized study (n=347 patients) between 2007-2015, comparing patients on incremental PD and full dose PD. Primary outcome in the study was anuria-free survival comparing IPD and full dose PD. Inversed probability weighted, adjusted anuria-free survival using time-dependent Cox proportional hazards model. This was an observational, single-center study, which included only CAPD patients with >200mL daily urine volume.