Decreasing the Burden: A Single-Centre Experience of Decremental Peritoneal Dialysis (PD) in Toronto, Canada
- Managing the Many Facets of Home Dialysis
November 03, 2023 | Location: Room 120, Pennsylvania Convention Center
Abstract Time: 05:06 PM - 05:15 PM
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
- Hamidi, Shabnam, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Qureshi, M Azfar, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Auguste, Bourne L., Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
The 2020 International Society of Peritoneal Dialysis (ISPD) recommendations on providing high-quality peritoneal dialyis (PD) prescriptions highlight shared-decision making principles that deemphasize the focus on Kt/V clearance targets. As a result, incremental PD has gained popularity amongst care providers in recent history. However, "decremental PD", a practice in which PD dose is reduced after patients are started on high dose PD (>10L/day), has not been well described in the literature. Decremental PD utilizes the principles of goal-directed therapy as outlined by the ISPD to reduce prescriptions where possible; particularly when treatment is burdensome for patients. We describe our experience with this approach and potential benefits to both patients and the healthcare system.
Nine prevalent patients on high-dose automated PD prescriptions seen between August 1-December 31, 2019, were included in this analysis. All patients reported prescriptions were burdensome. Patients were offered a reduced dose in their prescription after clinical assessment and laboratory investigations were reviewed. Patients were compared 6 months before and after the change in prescription for any significant differences in hospitalization, peritonitis rates and technique failure. Small solute clearance using Kt/V and creatinine clearance along with residual urine output were also compared.
Total dialysis volume and time on cycler were significantly reduced from a mean of 12.6 L to 9.2L (p <0.001) and from 8.7 to 8.2 hours (p <0.035). No statistically significant differences in Kt/V and CrCl values 6 months after the change in prescription were observed. There were no observed peritonitis episodes or hospitalizations six months after prescription change. All patients remained on PD 12 months after the intervention with no further prescription changes. The reduced prescription resulted in a 19.2% cost reduction per patient at six months compared to high-dose prescription.
We demonstrate that decremental PD prescriptions align with ISPD recommendations in maintaining patient-centered care while reducing cost.