Dr Ashik Hayat1,2,3, Associate Prof Yeoungjee Cho1,2,3, Professor Carmel Hawley1,2,3, Dr Htay Htay4, Associate Professor Rathika Krishnasamy2,5, Ms Elaine Pascoe2, professor Issac Teitelbaum6, Dr Marliene Varnfield2,7, Professor David Johnson1,2,3
11, PAH, Australia, 22, University Queensland, Australia, 33, Translational Research Institute, Australia , 44, Singapore general Hospital , Singapore, 55, Sunshine University, Australia, 66, University of Colorado, United States, 77, CSIRO, Australia
Incremental peritoneal dialysis (PD), defined as less than Full-dose PD prescription, has several possible merits, including better preservation of residual kidney function (RKF), lower peritoneal glucose exposure and reduced risk of peritonitis.
Methods:
Incident PD patients who participated in the balANZ randomized controlled trial (RCT) (2004-2010) and had at least one post-baseline RKF and urine volume (UV) measurements were included in this study. The primary and secondary outcomes were changes in measured RKF and daily UV, respectively.
Results:
The study included 154 patients (mean age 57.9 ± 14.1 years, 44% female, 33% diabetic, mean follow-up 19.5 ± 6.6 months). Incremental and Full-dose PD was commenced by 45 (29.2%) and 109 (70.8%) participants, respectively. RKF declined in Incremental group from 7.9±3.2mL/min/1.73m2 at baseline to 5.3±4.1mL/min/1.73m2 at 24 months, and in the Full-dose PD group from 7.3±2.7mL/min/1.73m2 at baseline to 3.3±2.3mL/min/1.73m2 at 24 months. The slopes of RKF decline were -0.011±0.002mL/min/1.73m2/year and -0.021±0.001mL/min/1.73m2/year, in the Incremental and Full-dose PD groups, respectively, (both p<0.001), and p<0.001 in comparison between the two slopes. Incremental PD was associated with significantly higher RKF following adjustment for clinical factors, and clinical plus PD related factors. Residual UV declined in the Incremental group from 1.81±0.73L/day at baseline to 1.39±0.10L/day at 24months, and in the Full-dose PD group from 1.38±0.61L/day at baseline to 0.61±0.46L/day at 24months. The slopes of residual UV decline were -0.009±0.002L/day/year and -0.018±0.002L/day/year, in the Incremental and Full-dose groups, respectively (both p<0.001), and p<0.001 in comparison between the two slopes.
Conclusions:
This study demonstrated that an Incremental PD strategy at PD commencement was significantly and independently associated with better preservation of RKF and residual UV than the Full-dose PD.
Biography:
Consultant Nephrology at PAH Brisbane and PhD candidate University of Queensland Brisbane Australia