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

Yeonhee Lee,Sung Won Chung,Hyunjin Ryu,Joongyub Lee,Kwon Wook Joo,Seokwoo Park,Curie Ahn,Kook-Hwan Oh,Hajeong Lee,Dong Ki Kim

doi:10.1038/s41598-019-46654-2

Yeonhee Lee, Sung Won Chung + Show 8 more

Open Access

https://doi.org/10.1038/s41598-019-46654-2

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Abstract

Maintaining residual renal function (RRF) is a crucial issue in peritoneal dialysis (PD). Incremental dialysis is the practice of initiating PD exchanges less than four times a day in consideration of RRF, and increasing dialysis dose in a step-wise manner as the RRF decreases. We aimed to compare the outcomes of incremental PD and full-dose PD in terms of RRF preservation and other outcomes. This was a single-center, observational study. Data were extracted retrospectively from a cohort of incident PD patients over 16 years old who started PD between 2007 and 2015 in the PD Unit of Seoul National University Hospital. We used inverse probability weighting (IPW) adjustment based on propensity scores to balance covariates between the incremental and full-dose PD groups. Multivariate, time-dependent Cox analyses were performed. Among 347 incident PD patients, 176 underwent incremental PD and 171 underwent conventional full-dose PD. After IPW adjustment, the incremental PD group exhibited a lower risk of developing anuria (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.43–0.88). Patient survival, technique survival, and peritonitis-free survival were all similar between these groups (P > 0.05 by log-rank test). Incremental PD was beneficial for preserving RRF and showed similar patient survival when compared to conventional full-dose PD.

Highlights

Incremental PD is the practice of initiating PD exchanges less than four times a day in consideration of residual renal function (RRF), and increasing dialysis dose in a step-wise manner as the RRF decreases, by achieving a minimum weekly Kt/V target of 1.7 as suggested by the NKF-KDOQI (National Kidney Foundation – Kidney Disease Outcomes Quality Initiative)[15] and ISPD (International society for peritoneal dialysis) 2006 Guidelines[16] and not falling below the acceptable minimum
Before adjustment using inverse probability weighting (IPW), patients in the incremental PD group were generally older, and a higher proportion were medium-risk patients by the Davies comorbidity index, compared with patients who initiated full-dose PD
The basic assumption of incremental dialysis is to reach the minimal target for adequate dialysis by summing renal function and dialysis dose

Summary

Introduction

Incremental PD is the practice of initiating PD exchanges less than four times a day in consideration of RRF, and increasing dialysis dose in a step-wise manner as the RRF decreases, by achieving a minimum weekly Kt/V target of 1.7 as suggested by the NKF-KDOQI (National Kidney Foundation – Kidney Disease Outcomes Quality Initiative)[15] and ISPD (International society for peritoneal dialysis) 2006 Guidelines[16] and not falling below the acceptable minimum This gradual initiation of dialysis may make the process of dialysis less invasive and better tolerated hemodynamically, as well as allowing for a greater adaptation to patients[17,18]. The objective of this study was to compare the outcomes of incremental PD and full-dose PD in terms of RRF preservation and other PD-related outcomes

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