Key result
Incremental peritoneal dialysis was associated with significantly higher hospitalization-free survival at 24 months (45% vs 20%, p=0.021) and similar patient survival compared to standard peritoneal dialysis.
Why the study?
Does incremental peritoneal dialysis improve survival, peritonitis incidence, hospitalization rates, and residual renal function preservation compared to standard peritoneal dialysis in incident PD patients?
Cohort (n=105)
No
Does incremental peritoneal dialysis improve survival, peritonitis incidence, hospitalization rates, and residual renal function preservation compared to standard peritoneal dialysis in incident PD patients?
Absolute Event Rate: 45% vs 20%
p-value: p=0.021
Incremental peritoneal dialysis is a safe modality to initiate PD that preserves residual renal function and reduces hospitalization rates compared to standard PD.
May support incremental PD to improve hospitalization-free survival; leaves open need for RCTs before practice change.
INTRODUCTION: Incremental dialysis consists in prescribing a dialysis dose aimed towards maintaining total solute clearance (renal + dialysis) near the targets set by guidelines. Incremental peritoneal dialysis (incrPD) is defined as one or two dwell-times per day on CAPD, whereas standard peritoneal dialysis (stPD) consists in three-four dwell-times per day. PATIENTS AND METHODS: Single-centre cohort study. Enrollement period: January 2002-December 2007; end of follow up (FU): December 2012. INCLUSION CRITERIA: incident patients with FU ≥6 months, initial residual renal function (RRF) 3-10 ml/min/1.73 sqm BSA, renal indication for PD. RESULTS: Median incrPD duration was 17 months (I-III Q: 10; 30). There were no statistically significant differences between 29 patients on incrPD and 76 on stPD regarding: clinical, demographic and anthropometric characteristics at the beginning of treatment, adequacy indices, peritonitis-free survival (peritonitis incidence: 1/135 months-patients in incrPD vs. 1/52 months-patients in stPD) and patient survival. During the first 6 months, RRF remained stable in incrPD (6.20 ± 2.02 vs. 6.08 ± 1.47 ml/min/1.73 sqm BSA; p = 0.792) whereas it decreased in stPD (4.48 ± 2.12 vs. 5.61 ± 1.49; p < 0.001). Patient survival was affected negatively by ischemic cardiopathy (HR: 4.269; p < 0.001), peripheral and cerebral vascular disease (H2.842; p = 0.006) and cirrhosis (2.982; p = 0.032) and positively by urine output (0.392; p = 0.034). Hospitalization rates were significantly lower in incrPD (p = 0.021). Eight of 29 incrPD patients were transplanted before reaching full dose treatment. CONCLUSIONS: IncrPD is a safe modality to start PD; compared to stPD, it shows similar survival rates, significantly less hospitalization, a trend towards lower peritonitis incidence and slower reduction of renal function.
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Sandrini et al. (2016) conducted a cohort in End-stage renal disease requiring peritoneal dialysis (n=105). Incremental peritoneal dialysis vs. Standard peritoneal dialysis was evaluated on Hospitalization-free survival at 24 months (p=0.021). Incremental peritoneal dialysis was associated with significantly higher hospitalization-free survival at 24 months (45% vs 20%, p=0.021) and similar patient survival compared to standard peritoneal dialysis.
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