L HUANG1,2, J MAH1, J HOWARD1, L MCMAHON1,2
1Department of Renal Medicine, Box Hill Hospital, 2Department of Medicine, Eastern Health Clinical School, Monash University
Aim: To describe characteristics and clinical outcomes of incident patients treated with incremental peritoneal dialysis (InPD) compared to standard PD (StPD).
Background: InPD is recommended as a component of high-quality PD care by the International Society for Peritoneal Dialysis; however, its usefulness and clinical outcomes have not been reported in Australia.
Methods: This was a retrospective cohort study of incident PD patients at Eastern Health between 2015 and 2019. InPD was defined in CAPD as using <8 L/day of PD fluid and in APD as dialysing without a last fill. Patients who stopped PD within 30 days were excluded. Dialysis modality accorded with patient and physician preference.
Results: 96 patients were included in this study; 54 of whom began with InPD. Compared to StPD, InPD patients were more likely to be female, had less comorbid diabetes (28% versus 52) and higher residual kidney function (Kt/V 2.0 ± 0.7 versus 1.4 ± 0.7). Age, BMI, use of renin-angiotensin antagonists, type of PD, starting serum creatinine, eGFR and urine volume did not differ between groups. InPD exposed patients to lower PD volumes (4.4 ± 2.1 L/day versus 8.5 ± 1.1) and glucose load (46 ± 41 g/day versus 119 ± 46). InPD was associated with longer technique survival (Log-rank test, P = 0.016), lower peritonitis rates (11.8 episodes/100 patient-year versus 22.9) and PD-related hospitalisations (15.7 admissions/100 patient-year versus 22.9). Diabetes and time to first peritonitis episode were associated with technique failure.
Conclusions: Incremental PD is a feasible starting prescription in many patients and was associated with lower peritonitis rates and longer technique survival. Validation of this prescription in prospective studies is warranted.
Louis is a nephrologist from Melbourne with interests in peritoneal dialysis, dialysis safety and renal fibrosis