FACTORS AFFECTING INCREMENTAL VS STANDARD PERITONEAL DIALYSIS PRESCRIPTION: A RETROSPECTIVE OBSERVATIONAL STUDY OF A PILOT PROGRAM AT WESTERN RENAL SERVICES

D SABANAYAGAM1, M A  NICDAO1, K  CHAU1,2, K SUD1, S TARAFDAR1

1Western Sydney Local Health District, Westmead and Blacktown, Australia, 2University of Western Sydney, Blacktown, Australia

Background: Most patients in Australia commencing on peritoneal dialysis (PD) are commenced on standard therapy at 8L dialysate per day, regardless of residual renal function or symptoms. Incremental PD (IPD) is standard practice in other centres with observational studies demonstrating longer preservation of RRF and similar survival rates to standard PD (SPD). In a pilot program, incident PD patients were prescribed IPD or SPD based on suitability determined by patient factors and RRF.
Aim: To examine what patient factors contribute to suitability to commence IPD and if there is a correlation between residual renal Kt/V and eGFR.
Method: Data was collected retrospectively on all incident PD patients between June 2019-July 2020, including cause of renal failure, co-morbidities, biochemistry, 24-hour urine and urea, and their dialysis prescription.
Results: Of the 72 patients incident PD patients, 52 (72%) were commenced on IPD. When compared to SPD group, IPD patients had lower serum creatinine (p=0.02) higher eGFR (p=0.02), 24-hour urine output (p=0.04), 24-hour urine output (p=0.004), residual renal Kt/V (p=0.001). Within the IPD cohort, reduction in eGFR was the main indication to commence PD (44.2% vs 27.8%), whilst in the SPD cohort, fluid overload was the main indication (45% vs 25%). There was no significant correlation between eGFR and Kt/V (p=0.129).
Conclusion: At the time of initiation, IPD patients have a higher RRF and a reduction in eGFR is more likely to be the precipitant to commence PD. Although residual renal Kt/V is the measure used to determine suitability and PD adequacy there was no significant correlation between the this and the eGFR. Further study is required to ascertain more reliable determinants of PD prescription in this population.


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