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Kidney Week

Abstract: PO1306

Use of Incremental Peritoneal Dialysis: Impact on Clinical Outcomes and Quality-of-Life Measures

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Naljayan, Mihran V., DaVita Inc, Denver, Colorado, United States
  • Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Hunt, Abigail, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Mckeon, Katherine L., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Schreiber, Martin J., DaVita Inc, Denver, Colorado, United States
  • Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States
Background

Incremental peritoneal dialysis (PD), defined as a PD prescription that is less than the standard, full-dose prescription, has been suggested as a means of preserving residual kidney function and offering better quality of life; however, published evidence is limited.

Methods

We considered adult patients initiating PD between 31 Jul 2015 and 31 May 2019. Patients with body weight <40 kg, limb amputation, or estimated glomerular filtration rate (eGFR) >20 mL/min during first 4 weeks on PD were excluded. Exposure group was ascribed (incremental vs full PD) based on PD prescription during dialysis weeks 5 to 8. Incremental PD was defined by treatment frequency, exchanges/day, and exchange volume (for continuous ambulatory PD [CAPD] patients) or by treatment frequency and presence/absence of last fill (for automated PD [APD] patients). Analyses were performed separately for CAPD and APD patients: for each, incremental PD patients were propensity score matched to eligible full PD patients. Patients were followed for up to 12 months until censoring for loss to follow-up or study end. Outcomes were compared using Poisson models (mortality, hospitalization, PD failure), linear mixed models (eGFR), and paired t-tests (Kidney Disease Quality of Life [KDQOL] domain scores).

Results

Among CAPD patients, compared to those on full PD, incremental PD use was associated with better KDQOL scores on 3 domains: physical composite score (42.5 vs 37.7, P=0.03), burden of kidney disease (60.2 vs 45.6, P=0.003), and effects of kidney disease (79.4 vs 72.3, P=0.05). Hospitalization and mortality rates were numerically lower (0.77 vs 1.12 admits/patient-year, P=0.09 and 5.0 vs 10.2 deaths/100 patient-years, P=0.22); there was no association with residual eGFR or PD failure rate. Use of incremental PD was not differentially associated with any outcome among APD patients.

Conclusion

These results suggest that it may be beneficial to use incremental PD in the context of CAPD, particularly with respect to quality of life. No significant benefits were detected among patients initiating APD. No detrimental effects of using incremental PD were observed for either PD type.