Outcomes of Incremental Versus Standard Peritoneal Dialysis

The efficacy and safety of incremental peritoneal dialysis (IPD) compared with standard full-dose peritoneal dialysis (SPD) are uncertain. IPD refers to the use of less than SPD in patients with ESRD. To provide clarity, Shuang Xu and colleagues conducted a systematic review of studies comparing mortality, peritonitis, technique survival, anuria-free survival, and residual renal function (RRF) between IPD and SPD.  

The researchers included 10 studies in the analysis. All comparative studies from the PubMed, Embase, CENTRAL, Scopus, and Web of Science databases published from inception to September 5, 2023, and reporting on given outcomes were eligible for inclusion.  

Qualitative synthesis was used to account for the heterogeneity of definitions of IPD. Most of the included studies did not demonstrate a difference in patient survival with IPD compared with SPD, nor did meta-analysis of crude mortality data reveal a difference. Peritonitis and technique survival did not differ significantly between IPD and SPD in most studies. However, data regarding RRF was conflicting, with some studies finding that IPD was associated with the preservation of RRF while others did not.  

In summary, IPD could provide a safe alternative to SPD for patients receiving incident dialysis. There appears to be no significant difference between the two modalities regarding patient survival, peritonitis, and technique survival. However, the impact of IPD on RRF remains unclear. 

Source: BMC Nephrology