Incremental Versus Standard (Full-Dose) Peritoneal Dialysis

Melissa S Cheetham; Yeoungjee Cho; Rathika Krishnasamy; Arsh K Jain; Neil Boudville; David W Johnson; Louis L Huang

doi:10.1016/j.ekir.2021.11.019

Incremental Versus Standard (Full-Dose) Peritoneal Dialysis

Kidney Int Rep. 2021 Dec 1;7(2):165-176. doi: 10.1016/j.ekir.2021.11.019. eCollection 2022 Feb.

Authors

Melissa S Cheetham^{1

2}, Yeoungjee Cho^{2

3

4

5}, Rathika Krishnasamy^{1

2

3}, Arsh K Jain⁶, Neil Boudville^{7

8}, David W Johnson^{2

3

4

5}, Louis L Huang⁹

Affiliations

¹ Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Australia.
² Faculty of Medicine, The University of Queensland, Brisbane, Australia.
³ Australasian Kidney Trials Network at the University of Queensland, Brisbane, Australia.
⁴ Translational Research Institute, Brisbane, Australia.
⁵ Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
⁶ Schulich School of Medicine & Dentistry, Department of Epidemiology & Biostatistics, Western University, London, Canada.
⁷ Medical School, University of Western Australia, Perth, Australia.
⁸ Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.
⁹ Department of Renal Medicine, Eastern Health Clinical School, Monash University, Melbourne, Australia.

Abstract

Incremental peritoneal dialysis (PD), defined as less than "standard dose" PD prescription, has a number of possible benefits, including better preservation of residual kidney function (RKF), reduced risk of peritonitis, lower peritoneal glucose exposure, lesser environmental impact, and reduced costs. Patients commencing PD are often new to kidney replacement therapy and possess substantial RKF, which may allow safe delivery of an incremental prescription, often in the form of lower frequency or duration of PD. This has the potential to help improve quality of life (QOL) and life participation through reducing time requirements and burden of treatment. Alternatively, incremental PD could potentially contribute to reduced small solute clearance, fluid overload, or patient reluctance to increase dialysis prescription when later needed. This review discusses the definition, rationale, uptake, potential advantages and disadvantages, and clinical trial evidence pertaining to the use of incremental PD.

Keywords: incremental dialysis; patient-centered care; peritoneal dialysis; personalized medicine; quality of life.

Publication types

Review