Kidney Week

Abstract: TH-PO317

Incremental Peritoneal Dialysis in Incident ESKD Patients

Session Information

• Peritoneal Dialysis: CVD, Fluid, Nutrition
  November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 703 Dialysis: Peritoneal Dialysis

Authors

• Yan, Hao, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China, Shanghai, China

Hao Yan,

• Bargman, Joanne M., Toronto General Hospital, Toronto, Ontario, Canada

Joanne M. Bargman,

Background

Incremental peritoneal dialysis (Incre-PD) has been an underused strategy in treating end stage kidney disease (ESKD). This retrospective study analyzed the characteristics and outcomes of ESKD patients undergoing Incre-PD in a large academic center.

Methods

ESKD patients initiating PD with a contact PD volume ≤6 L/day between 2013 and 2017 inclusive were followed up until death, PD cessation, or the end of 2018.

Results

175 Incre-PD patients were identified, accounting for 85% of the incident patients of that period，and were followed up for 352.6 patient-years. Compared to those with initial PD dose >6 L/day, there were more Asians (24.0% vs. 6.7%, p=0.033) but fewer of African descent (13.7% vs. 36.7%, p=0.002) among the Incre-PD patients. The two cohorts were comparable in comorbidity status except for peripheral vascular disease, which was more common in Incre-PD patients (14.3% vs. 0.0%, p=0.030). The baseline urine volume (1.5±0.7 L/day vs. 1.0±0.9 L/day, p=0.001) and residual kidney function (RKF, 8.3±3.4 mL/min/1.73m² vs. 5.5±3.2 ml/min/1.73m², p<0.001) were greater in Incre-PD patients, and they were less likely to have undergone hemodialysis (HD) prior to PD (19.4% vs. 50.0%, p<0.001). The baseline daily contact PD volume was 4.5 (IQR 4.3-6) L, and it was 5.4 (4.5-6.0) L, 6.0 (4.5-7.0) L, 6.0 (4.8-8.0) L, 7.0 (5.7-9.8) L, and 8.0 (6.0-9.8) L at 1 to 5 years on PD, respectively. Fifty-seven (32.6%) patients increased PD dose to >6 L/day at a median time of 10.3 (6.2, 15.7) months. The unadjusted 1 to 5-year patient survival rate was 90%, 80%, 65%, 63%, and 49%, respectively, and the corresponding PD technique survival rate was 95%, 89%, 89%, 82%, and 77%. The average peritonitis rate and hospitalization rate was 0.12 and 0.65 episodes per patient-year, respectively. The length of hospitalization was 5.9 days per patient-year. Greater initial daily contact PD volume (HR=1.608, 95% CI 1.089-2.375) was associated with death after adjusting for age, Charlson comorbidity index, HD prior to PD, assisted PD and baseline RKF, likely as a result of residual confounding. It was not a factor related to technique failure. Male sex, greater body mass index and lower serum albumin at PD initiation were risk factors for increasing PD dose to >6 L/day within 1 year.

Conclusion

In the largest reported series to date, Incre-PD is a successful and patient-oriented strategy to treat ESKD patients.