Patients With Nonfast Peritoneal Transfer Rate are More Suitable for Incremental Peritoneal Dialysis

This is the authors' abstract. We don't add key points for this paper.

Introduction Previous studies have shown that incremental peritoneal dialysis (iPD) improves the prognosis of patients with PD and tolerable residual kidney function (RKF). The peritoneal solute transfer rate (PSTR) characterizes peritoneal ultrafiltration and solute transfer. However, the most appropriate recipients of iPD have not been identified. Therefore, we hypothesized that patients with different PSTRs would experience different clinical benefits of iPD therapy. Methods We studied patients with RKF who initiated CAPD at our center. The enrolled patients were allocated to fast and non-fast PSTR groups, and then to iPD or full-dose PD. To mitigate the influence of confounding factors, propensity score matching was employed. The clinical outcomes associated with iPD and full-dose PD in the fast and non-fast PSTR groups were compared. Results A total of 974 CAPD patients were enrolled. The median duration of maintenance using iPD for the non-fast PSTR group was longer than that for the fast PSTR group (21.0 vs. 15.6 months, P =0.011). Patients in non-fast PSTR group who underwent iPD had lower risks of mortality [hazard ratio (HR) 0.25, P =0.002], anuria (HR 0.53, P =0.003), and cardiovascular mortality (HR 0.36, P =0.047) than those who underwent full-dose PD after matching. However, these clinical benefits of iPD therapy were not present in the fast PSTR group. Conclusions Patients who show non-fast PSTR maintain iPD longer and experience superior clinical benefits than those who undergo fast PSTR. Therefore, patients who experience non-fast PSTR may be more suitable for iPD therapy than those who experience fast PSTR.

iPD benefits may differ by PSTR in PD patients; leaves open optimal selection for incremental regimens.