Incremental peritoneal dialysis: Is it better for preservation of residual kidney function and clinical outcomes?
Adriana Barrinha Fernandes, Patrícia Matias, Patrícia Branco
Abstract
INTRODUCTION: Incremental peritoneal dialysis (IPD) is based on the prescription of a dose lower than the standard (SPD). The combination of residual kidney function (RKF) and peritoneal clearance achieves clearance goals. The aim of this study is to compare the outcomes of IPD with SPD. MATERIALS AND METHODS: This was a single-center, retrospective study that included a cohort of prevalent peritoneal dialysis (PD) adults. Patients were assigned according to their first PD protocol in two groups - group A: IPD protocol (continuous ambulatory PD: less than 4 dwells daily, less than 2 L dwell volume, and/or treatment less than 7 days/week; automated PD: without a long dwell, less than 10 L daily delivered, and/or treatment for less than 7 days/week); group B: SPD protocol. RESULTS: at 24 months (OR 13 per point, 95% CI 1.48 - 114.36, p = 0.021). IPD was also associated with a longer technique survival (log-rank test = 4.928, 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). Cox regression demonstrated that IPD (HR 0.30; 95% CI 0.098 - 0.93); p = 0.036) was associated with a decrease in the risk of technique failure. CONCLUSION: The prescription of IPD seems to be beneficial, in terms of outcomes, for patients with substantial RKF.