Incremental PD
Ease the transition to home dialysis for patients with Incremental PD
Incremental PD
Starting dialysis at less than full dose when there is still significant renal function1
Person-centered approach
Incremental PD decreases workload of dialysis2
Multiple Benefits
Incremental PD may preserve kidney function better than full dose dialysis3
Start with Incremental PD and preserve the choice of PD
When the modality choice is PD, choose Incremental PD
- Incremental PD, where less than standard ‘full-dose’ PD is prescribed in people initiating PD and done with the intention of increasing the prescription if and when residual kidney clearance declines, may ease the transition to dialysis for patients with chronic kidney disease – fewer exchanges, more time to do the things that matter to them1
- Starting patients on Incremental PD allows a person-centered approach by significantly reducing the workload of dialysis for those doing PD, reduces exposure of the peritoneal membrane to glucose, and may lessen mechanical symptoms2
- The dialysis dose is gradually increased to compensate for renal function decline and to meet adequacy targets3
“You don’t have to feel bad before you feel better”4
Physician to her patient: Physician Survey
Incremental PD offers clinical, economic and lifestyle benefits
Incremental PD strategies achieve outcomes that are at least as good as full dose PD prescriptions in patients with RKF1
RKF preservation without increased risk of peritonitis3,5,*,†
Lower hospitalization rates vs. standard PD5,†
Protection of patient modality goal6
• PD option often lost at low GFR if insufficient time for catheter insertion and training
• Urgent start PD often not available
Benefits may include7,8
• Improvement of uremic symptoms
• Reduces burden on patient
• Allows more time for the patient to adjust to dialysis therapy
• Minimized glucose exposure
Lower cost9
Incremental PD may preserve kidney function better than full-dose PD without increasing risk of Peritonitis3
Incremental PD was beneficial for preserving residual renal function as demonstrated by a longer anuric free time as compared to full-dose PD.3
Overall median time to the first peritonitis was 2.3 years for patients on Incremental PD and full dose3,*
Study Design
A single center, retrospective cohort study of incident patients (n=347 patients between January 2007 through December 2015) was conducted to compare incremental PD with full-dose PD with the following specifications3
| Incremental PD Arm | Full Dose PD Arm |
| 1-2 dwells per day on CAPD, 7 days a week | The initiation of PD with 3 or more exchanges per day for CAPD, 7 days a week |
| A peritoneal Kt/V < 1.7 per week, but a total Kt/V ≥ 1.7 per week | Irrespective of residual renal function (RRF) |
| Baseline GR 6.9 ± 3.00 | Baseline GFR: 6.5 ± 2.43 |
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| First Episode | ||
| Incremental PD (n=176) | Full-dose PD (n=171) | |
| Number of first peritonitis | 71 | 73 |
| Follow-up time (patient-year) | 692.9 | 750.0 |
| Peritonitis incidence (episode / patient-year) (95% CI) | 0.10 (0.08-0.13) | 0.10 (0.08-0.12) |
| Incidence of first peritonitis (144 episodes among 347 study participants). Abbreviations: PD, peritoneal dialysis; CI, confidence interval.3 | ||
Adapted from Lee Y, et al. Sci Rep 2019;9(10105):1-7.