Effects of incremental peritoneal dialysis in patients with urgent-start peritoneal dialysis

Abstract: Objective: To observe the feasibility and effects of the incremental peritoneal dialysis in patients receiving urgent-start peritoneal dialysis. Methods: This is a single-center retrospective study. ESRD patients who received urgent-start peritoneal dialysis from August 1st2018 through July 31st2021 at the first affiliated hospital of Xi'an Jiaotong University were enrolled to this study. The estimated glomerular filtration rate (eGFR) of all patients was between 4 ~ 6ml/min/1.73m2.According to the difference in the initial dialysis dose, recruited patients were divided into an incremental PD group: initial dialysis dose less than or equal to 6000mlper day, with the dialysis dose being adjusted according to the RRF and dialysis adequacy, and a full-dose PD group: dialysis dose more than or equal to 8000ml per day. Patients were followed-up for 1 year. Clinical biochemical indices, dialysis dose, dialysis adequacy, urine volume, dialysis ultra-filtration volume, residual renal function and peritoneal dialysis-related complications were recorded when peritoneal dialysis was performed at 1,3, and 6-months and 1year. Results: 1. This study examined 169 patients, of which, 111 patients with a mean age of 45.01±12.84 years were in the incremental PD group and 58 patients with a mean age of 43.5±15.62 years were in the full-dose PD group. The demographics, the clinical biochemical indices and residual renal function of both groups before peritoneal dialysis were similar(P＞0.05). 2. During follow-up, the dialysis dose in the full-dose PD group exceeded that of the incremental PD group (P<0.05). However, the total Kt/V for both groups exceeded 1.7, and the total Ccr was greater than 50L. At 1 and 6 months, the urine Kt/V in the incremental PD group was higher than that found in the full-dose PD group (P<0.05). 3.During the whole follow-up period, blood pressure control, correction of anemia, and correction of hypocalcemia were also similar for both groups (P>0.05).The correction of hyperphosphatemia in both groups reached the standard.4. During the follow-up period, the residual renal function in both group were similar (P>0.05). The dialysis ultra-filtration volume in the full-dose PD group exceeded that of the incremental PD group, but the differences were not statistically significant (P>0.05).The urine volume of the incremental PD group were significantly higher than that of the full-dose PD group, especially at 1 month and 6 months of dialysis(P<0.05). 5. During the entire follow-up, no patient died in either group. The peritoneal dialysis-related infection, mechanical complications and technical survival rate were similar between groups (P>0.05). Conclusions: The dialysis effect and complications from incremental PD, were similar to full-dose peritoneal dialysis. Incremental PD did not cause a rapid decline of residual renal function in USPD patients. Therefore, USPD patients can be treated by incremental peritoneal dialysis.