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Incremental peritoneal dialysis

Blake, Peter G.; Dong, Jie; Davies, Simon J.


Peter G. Blake

Jie Dong


Incremental peritoneal dialysis (PD) has been variably defined. It involves taking advantage of the residual renal function that is usually present at initiation of dialysis to initially prescribe less onerous lower doses of PD while still achieving individualized clearance goals. We propose that incremental PD be defined as a strategy, rather than a particular regime, in which: (1) less than standard "full-dose" PD is initially prescribed in recognition of the value of residual renal function; (2) peritoneal clearance is initially less than the individualized clearance goal but the combination of peritoneal plus renal clearance achieves or exceeds that goal clearance; and (3) there is a clear intention to increase dose of PD as renal clearance declines and/or symptoms appear. Incremental PD by its nature lessens the workload of dialysis for those doing PD, reduces cost and exposure of the peritoneal membrane to glucose, and may lessen mechanical symptoms. Evidence that incremental PD improves clinical outcomes compared to the use of full-dose PD is lacking but one randomized controlled trial, multiple observational studies, and a systematic review all suggest that outcomes are at least as good. Given that incremental PD costs less and is inherently less onerous, it is reasonable, pending larger randomized trials, to adopt this strategy.

Journal Article Type Article
Acceptance Date Jan 17, 2020
Online Publication Date Jan 17, 2020
Publication Date 2020-05
Publicly Available Date May 26, 2023
Print ISSN 0896-8608
Publisher SAGE Publications
Volume 40
Issue 3
Pages 320 - 326
Keywords Incremental peritoneal dialysis, patient-centered care, peritoneal dialysis
Publisher URL