Incremental Peritoneal Dialysis May be Beneficial for Preserving Residual Renal Function Compared to Full-dose Peritoneal Dialysis

Yeonhee Lee, Sung Won Chung, Seokwoo Park, Hyunjin Ryu, Hajeong Lee, Dong Ki Kim, Kwon Wook Joo, Curie Ahn, Joongyub Lee, Kook-Hwan Oh, Yeonhee Lee, Sung Won Chung, Seokwoo Park, Hyunjin Ryu, Hajeong Lee, Dong Ki Kim, Kwon Wook Joo, Curie Ahn, Joongyub Lee, Kook-Hwan Oh

Abstract

Maintaining residual renal function (RRF) is a crucial issue in peritoneal dialysis (PD). Incremental dialysis is the practice of initiating PD exchanges less than four times a day in consideration of RRF, and increasing dialysis dose in a step-wise manner as the RRF decreases. We aimed to compare the outcomes of incremental PD and full-dose PD in terms of RRF preservation and other outcomes. This was a single-center, observational study. Data were extracted retrospectively from a cohort of incident PD patients over 16 years old who started PD between 2007 and 2015 in the PD Unit of Seoul National University Hospital. We used inverse probability weighting (IPW) adjustment based on propensity scores to balance covariates between the incremental and full-dose PD groups. Multivariate, time-dependent Cox analyses were performed. Among 347 incident PD patients, 176 underwent incremental PD and 171 underwent conventional full-dose PD. After IPW adjustment, the incremental PD group exhibited a lower risk of developing anuria (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.43-0.88). Patient survival, technique survival, and peritonitis-free survival were all similar between these groups (P > 0.05 by log-rank test). Incremental PD was beneficial for preserving RRF and showed similar patient survival when compared to conventional full-dose PD.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow of patients in the cohort. PD, peritoneal dialysis; HD, hemodialysis.
Figure 2
Figure 2
Inversed probability weighted, adjusted anuria-free survival using time-dependent Cox proportional hazards model.
Figure 3
Figure 3
Kaplan-Meier survival estimates using inverse probability weighting (IPW).

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