Perceptions and Patterns Associated with Incremental Peritoneal Dialysis Use

Incremental peritoneal dialysis (PD) is defined as prescribing a “less-than-standard” PD dose. High-certainty evidence to guide safe incremental PD prescription is lacking, resulting in substantial practice variability. We conducted a multi-national survey to evaluate current uptake, practice patterns and clinician perspectives on incremental PD. An online, unit-level survey, comprising 27 questions on incremental PD practice, was purposively disseminated to senior PD unit staff (physicians and/or nurses) from Australia, Canada and Thailand between June 2023 and September 2025. A total of 254 responses were received from 175 PD units (Australia: 55 (89%) of 62 units; Canada: 49 (60%) of 82 units; Thailand: 71 (34%) of 210 units). Incremental PD was reported as prescribed in fewer than 10% of patients in most units (56%, P=0.16). Incremental PD definitions varied substantially: CAPD with <4 daily exchanges (75%), APD or CAPD performed <7 days/week (65% and 61%), CAPD <8 L/day (50%), a single long overnight exchange (46%), or APD without a day dwell (44%), highlighting the absence of international consensus. Key reported advantages included increased patient satisfaction (81%), willingness to choose PD (75%) and preservation of residual kidney function (64%). Frequently cited disadvantages included patient or caregiver resistance to dose escalation (62%) and needing more frequent monitoring (31%). Quality of life was identified as the most important area for future research. Incremental PD is prescribed infrequently and variably. Concern about patient resistance to dose escalation is a barrier. High-quality data are needed to guide how incremental PD is defined, initiated and escalated.