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Incremental PD

Ease the transition to home dialysis for patients with Incremental PD

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Incremental PD

Starting dialysis at less than full dose when there is still significant renal function1

Person Centered Approach icon

Person-centered approach

Incremental PD decreases workload of dialysis2

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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
Chart showing increase in PD over RKF
“
“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

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Incremental PD strategies achieve outcomes that are at least as good as full dose PD prescriptions in patients with RKF1

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RKF preservation without increased risk of peritonitis3,5,*,†

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Lower hospitalization rates vs. standard PD5,†

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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

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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

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Lower cost9

Incremental PD may preserve kidney function better than full-dose PD without increasing risk of Peritonitis3

Graph showing Inversed probability weighted, adjusted anuria-free survival for incremental PD and full-dose PD

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
  • No significant difference in sex, the composition of primary renal disease comorbidities, and the use of ACEI or ARB between the two groups
  • Exclusion criteria: Total duration of PD less than 6 months, initiation of PD at another hospital, urine volume of < 200 mL per day at the time of initiating PD, previous hemodialysis, less than 16 years of age

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.

* Study design: A retrospective, randomized study (n=347 patients) between 2007-2015, comparing patients on incremental PD and full dose PD. Primary outcome in the study was anuria-free survival comparing IPD and full dose PD. Inversed probability weighted, adjusted anuria-free survival using time-dependent Cox proportional  hazards model.  This was an observational, single-center study, which included only CAPD patients with >200mL daily urine volume.

 

† Study design: A 10-year single center study (n=100) between 2002-2012 comparing incident patients on incremental PD and standard PD.

Related Pages

Previous page

PD allows patients to dialyze at home and minimize the risk of viral infections

Safety

Next page

Prioritize PD, a more cost-effective therapy than ICHD, to lower overall healthcare costs and, with Remote Patient Management (RPM), to reduce hospitalization costs

Economic Value
References

  1. Brown EA, et al. International Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goaldirected peritoneal dialysis. Perit Dial Int. 2020;40(3):244–253. 

  2. Blake PG, et al. Incremental peritoneal dialysis. Perit Dial Int. 2020;40(3):320-326.

  3. Lee Y, et al. Incremental Peritoneal Dialysis May be Beneficial for Preserving Residual Renal Function Compared to Full-dose Peritoneal Dialysis. Sci Rep 2019;9(10105):1-7 

  4. Baxter Data on File, IPD market research October 30,2019. 

  5. Sandrini M, et al. Incremental peritoneal dialysis: a 10 year single-centre experience. J Nephrol. 2016;29(6):871-879.

  6. Blake PG, Jain AK. Urgent Start Peritoneal Dialysis: Defining What It Is and Why It Matters. Clin J Am Soc Nephrol. 2018;13(8):1278-1279. 

  7. Bargman JM, Girsberger M. Visions in a Crystal Ball: The Future of Peritoneal Dialysis. Blood Purif. 2018;45(1-3):218-223. 

  8. Auguste BL, Bargman JM. Incremental peritoneal dialysis: New ideas about an old approach. Semin Dial. 2018;31(5):445-448. 

  9. Ankawi GA, et al. The Use of Incremental Peritoneal Dialysis in a Large Contemporary Peritoneal Dialysis Program. Can J Kidney Health Dis. 2016;3:1-7