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      Incremental peritoneal dialysis

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          Abstract

          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.

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          Author and article information

          Journal
          Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
          Perit Dial Int
          SAGE Publications
          0896-8608
          1718-4304
          May 2020
          January 17 2020
          May 2020
          : 40
          : 3
          : 320-326
          Affiliations
          [1 ]Division of Nephrology, Western University, London, ON, Canada
          [2 ]Department of Medicine, Peking University First Hospital, Beijing, China
          [3 ]Institute of Nephrology, Peking University, Beijing, China
          [4 ]Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
          [5 ]Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
          [6 ]Faculty of Medicine and Health Sciences, Keele University, Stoke-on-Trent, UK
          Article
          10.1177/0896860819895362
          32063212
          0ed62f32-ce91-465a-98cf-d96cac324811
          © 2020

          http://journals.sagepub.com/page/policies/text-and-data-mining-license

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