Abstract Background and Aims Incremental peritoneal dialysis (IPD) is based on the prescription of a dose lower than the standard “full dose” (SPD). The achievement of individualized clearance goals is based on the combination of peritoneal and renal clearance. IPD as the initial PD strategy seems to be a convenient and resource-sparing technique, but its impact in long term outcomes and in the environment lacks evidence. The aim of this study is to evaluate IPD outcomes and to analyze the potential impact of this initial approach on costs, total and plastic waste, and water consumption. Method Single-center observational retrospective study that included a cohort of 87 prevalent PD adults. Patients were assigned in two groups according to their initial PD prescription—IPD group [continuous ambulatory PD (CAPD): less than 4 dwells daily, less than 2L dwell volume, and/or PD less than 7 days/week; automated PD (APD): without a long dwell, less than 10 L delivered, and/or PD for less than 7 days/week] and SPD group. Primary outcomes were residual kidney function preservation, technique survival and mortality. Secondary outcomes were peritonitis rate and hospitalizations. The reductions related to costs, total and plastic waste, and water usage were also compared between groups. Results In 57 (65%) of the patients IPD was the initial therapy, while 30 (35%) patients were prescribed SPD. The median follow-up was 23 months and the median transition time from 2 to 3 and from 3 to 4 exchanges were 6 and 14 months in CAPD, respectively. APD patients transitioned to SPD after a median of 9 months. Patients in IPD group had a higher glomerular filtration rate (7 vs. 3.7, mL/min/1.73 m2, p < 0.001) in the first 6 months, and after 24 months (4.8 vs. 1.9, mL/min/1.73 m2, p = 0.002. IPD was also associated with a longer technique survival (p = 0.026), lower hospital admissions per year (0.23 vs. 0.5, p = 0.001), and lower mortality (1.8% vs. 13.3%, p = 0.027). Compared to SPD, 2 and 3 exchanges per day led to a reduction in costs of approximately 8500 or 4100 euros/patient-year, total waste of 266 or 143 kg/year/patient, in plastic waste of 159 or 69 kg/year/patient, and water savings of 28,620 or 12,420 L/year/patient, respectively. In APD, IPD led to a reduction of 4400 euros/ patient-year in cost, 211 kg/year/patient in total and of 139 kg/year/patient in plastic waste, and water savings of 25,020 L/year/patient. Conclusion Prescription of initial individualized IPD is associated with better clinical outcomes in patients with substantial RKF. This approach was a significant economic and environmental impact, with a reduction in total and plastic waste, and water consumption.
Read full abstract