Retrospective analysis of advantages and disadvantages of incremental peritoneal dialysis

Objective To explore the advantages and disadvantages of incremental peritoneal dialysis(incr-PD) versus standard peritoneal dialysis(st-PD) in dialysis adequacy,peritonitis and residual kidney function(RKF) and provide further rationales for clinical application of incr-PD.Methods For this single-center retrospective cohort study,PD patients admitted from January 1,2012 to December 31,2018 were collected.According to the inclusion and exclusion criteria,they were assigned into two groups of incremental(n=78) and standard(n=37) dialysis scheme.Baseline profiles,related parameters of 3/6/12/24/36 months post-dialysis were compared between two groups.At the same time,peritoneal infection frequency,peritonitis-free survival time,average change of urine volume,urine-free survival time,initial peripheral edema time,hospitalization rate,mortality rate,PD survival time and dialysis cost in the first year were compared between two groups.Results Baseline profiles between two groups were not significantly different (all P≥0.05).Initial urine volume was significantly different(1030.00 vs 906.50 mL,P= 0.014).After 3-month PD,total Kt/V(1.85 vs 1.51,P＜0.001) and total creatinine clearance rate(77.25 vs 61.57 L/week,P=0.006) were higher in incremental group than those in standard group.After 6-month PD,total creatinine clearance was higher in incremental group than those in standard group(54.23 vs 37.19 L/week,P= 0.010).No significant difference existed in the above parameters during follow-ups (all P≥ 0.05).At the end of follow-ups,incremental group had better urine-free survival time(24.00 vs 15.00/month,P=0.017) ,lower urine volume(39.04 vs 59.71 mL/month,P=0.022) ,lower eGFR2.95 vs 4.54 mL·min^-1·(1.73m²)^-1 ,P=0.003 ,peritonitis-free survival time(22.00 vs 14.00/month,P=0.035) ,hospitalization rate(0.09 vs 0.15 times/patient-months,P＜0.001) and dialysis cost in the first year (32 000 vs 42 700 yuan) than standard group.No significant inter-group differences existed in initial peripheral edema time(13.50 vs 13.00/month,P=0.673),PD survival time(28.50 vs 25.00/month,P=0.515),TOT(42.96 vs 43.62/month,P=0.335) ,DOR(first year 14.10% vs 16.21%,second year 39.74% vs 48.65%,third year 56.41% vs 62.16%,P=0.937)or mortality rate(7.69% vs 13.51%,P=0.487).Meanwhile,age,gender,hypertension and diabetes mellitus did not affect PD survival time.However,peritoneal infection frequency and urine-free survival time were important risk factors.Conclusion Incr-PD is completely feasible in ESRD patients with residual renal function.Incr-PD does not affect PD survival time,time on therapy,dropout rate,mortality or dialysis adequacy.At the same time,it may arrest the deterioration of kidney function,prolong peritonitis-free survival time,lower hospitalization rate and reduce medical expenses.