Skip to main content

Advertisement

SpringerLink
Log in

Effects of incremental peritoneal dialysis with low glucose-degradation product neutral pH solution on clinical outcomes

  • Nephrology – Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

Incremental peritoneal dialysis (IPD) could decrease unfavorable glucose exposure results and preserve (RKF). However, there is no standardization of dialysis prescriptions for patients undergoing IPD. We designed a prospective observational multi-center study with a standardized IPD prescription to evaluate the effect of IPD on RKF, metabolic alterations, blood pressure control, and adverse outcomes.

Methods

All patients used low GDP product (GDP) neutral pH solutions in both the incremental continuous ambulatory peritoneal dialysis (ICAPD) group and the retrospective standard PD (sPD) group. IPD patients started treatment with three daily exchanges five days a week. Control-group patients performed four changes per day, seven days a week.

Results

A total of 94 patients (47 IPD and 47 sPD) were included in this study. The small-solute clearance and mean blood pressures were similar between both groups during follow-up. The weekly mean glucose exposure was significantly higher in sPD group than IPD during the follow-up (p < 0.001). The patients with sPD required more phosphate-binding medications compared to the IPD group (p = 0.05). The rates of peritonitis, tunnel infection, and hospitalization frequencies were similar between groups. Patients in the sPD group experienced more episodes of hypervolemia compared to the IPD group (p = 0.007). The slope in RKF in the 6th month was significantly higher in the sPD group compared to the IPD group (65% vs. 95%, p = 0.001).

Conclusion

IPD could be a rational dialysis method and provide non-inferior dialysis adequacy compared to full-dose PD. This regimen may contribute to preserving RKF for a longer period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The data could be participated in case of request.

References

  1. Churchill DN, Thorpe KE, Vonesh EF, Keshaviah PR (1997) Lower probability of patient survival with continuous peritoneal dialysis in the United States compared with Canada. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 8:965–971

    Article  CAS  PubMed  Google Scholar 

  2. Paniagua R, Amato D, Vonesh E, Correa-Rotter R, Ramos A, Moran J, Mujais S, Group MNCS (2002) Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol 13:1307–1320

    Article  CAS  PubMed  Google Scholar 

  3. Termorshuizen F, Korevaar JC, Dekker FW, van Manen JG, Boeschoten EW, Krediet RT (2003) The relative importance of residual renal function compared with peritoneal clearance for patient survival and quality of life: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2. Am J Kidney Dis 41:1293–1302

    Article  PubMed  Google Scholar 

  4. Fernandes A, Matias P, Branco P (2023) Incremental peritoneal dialysis—definition, prescription, and clinical outcomes. Kidney360 4:272–277

    Article  PubMed  Google Scholar 

  5. Golper T, Churchill D, Burkart J, Firanek C, Geary D, Gotch F, Moore L, Nolph K, Powe N, Singh H (1997) NKF DOQI clinical practice guidelines for peritoneal dialysis adequacy. Am J Kidney Dis 30:S67-136

    Article  Google Scholar 

  6. Dhoot A, Brown EA, Robinson B, Perl J (2023) Incremental peritoneal dialysis: incremental gains. SAGE Publications, London, pp 355–358

    Google Scholar 

  7. Brown EA, Blake PG, Boudville N, Davies S, de Arteaga J, Dong J, Finkelstein F, Foo M, Hurst H, Johnson DW (2020) International society for peritoneal dialysis practice recommendations: prescribing high-quality goal-directed peritoneal dialysis. Perit Dial Int 40:244–253

    Article  PubMed  Google Scholar 

  8. Cheetham MS, Cho Y, Krishnasamy R, Jain AK, Boudville N, Johnson DW, Huang LL (2022) Incremental versus standard (full-dose) peritoneal dialysis. Kidney Int Rep 7:165–176

    Article  PubMed  Google Scholar 

  9. Auguste BL, Bargman JM (2018) Incremental peritoneal dialysis: new ideas about an old approach. Semin Dial 31:445–448

    Article  PubMed  Google Scholar 

  10. Nolph KO, Khanna R, Prowant BF, Ryan LP, Moore HL, Nielsen MP (1987) Peritoneal equilibration test. Perit Dial Int 7:138–148

    Article  Google Scholar 

  11. Li PKT, Chow KM, Cho Y et al (2022) ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Perit Dial Int 42(2):110–153

    Article  PubMed  Google Scholar 

  12. Hayat A, Cho Y, Hawley CM, Htay H, Krishnasamy R, Pascoe E, Teitelbaum I, Varnfield M, Johnson DW (2023) Association of incremental peritoneal dialysis with residual kidney function decline in patients on peritoneal dialysis: the balANZ trial. Perit Dial Int. https://doi.org/10.1177/08968608231175826

    Article  PubMed  Google Scholar 

  13. Cheetham MS, Cho Y, Krishnasamy R, Milanzi E, Chow J, Hawley C, Moodie J-A, Jose MD, MacGinley R, Nguyen T (2023) Multicentre registry analysis of incremental peritoneal dialysis incidence and associations with patient outcomes. Perit Dial Int 43:383–394

    Article  CAS  PubMed  Google Scholar 

  14. Sandrini M, Vizzardi V, Valerio F, Ravera S, Manili L, Zubani R, Lucca BJ, Cancarini G (2016) Incremental peritoneal dialysis: a 10 year single-centre experience. J Nephrol 29:871–879

    Article  PubMed  PubMed Central  Google Scholar 

  15. Tomo T, Okabe E, Matsuyama K, Iwashita T, Yufu K, Nasu M (2005) The effect of peritoneal rest in combination therapy of peritoneal dialysis and hemodialysis: using the cultured human peritoneal mesothelial cell model. J Artif Organs 8:125–129

    Article  PubMed  Google Scholar 

  16. Ueda A, Nagai K, Yamagata K (2021) Preserved peritoneal function by short-term two-day peritoneal rest in hemodialysis combination therapy patients. J Artif Organs 24:296–300

    Article  CAS  PubMed  Google Scholar 

  17. Alrowiyti IM, Bargman J (2023) A review of residual kidney function in peritoneal dialysis patients. Indian J Nephrol 33:239–246

    Article  PubMed  PubMed Central  Google Scholar 

  18. Menon MK, Naimark DM, Bargman JM, Vas SI, Oreopoulos DG (2001) Long-term blood pressure control in a cohort of peritoneal dialysis patients and its association with residual renal function. Nephrol Dial Transpl 16:2207–2213

    Article  CAS  Google Scholar 

  19. Wang AY-M, Wang M, Woo J, Lam CW-K, Lui S-F, Li PK-T, Sanderson JE (2004) Inflammation, residual kidney function, and cardiac hypertrophy are interrelated and combine adversely to enhance mortality and cardiovascular death risk of peritoneal dialysis patients. J Am Soc Nephrol 15:2186–2194

    Article  CAS  PubMed  Google Scholar 

  20. Rhee H, Yang JY, Jung WJ, Shin MJ, Yang BY, Song SH, Kwak IS, Seong EY (2014) Significance of residual renal function for phosphate control in chronic hemodialysis patients. Kidney Res Clin Pract 33:58–64

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Hacettepe University, TR-06560, Ankara, Turkey

    Hasan Haci Yeter & Arda Erdut

  2. Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Ataturk University, Erzurum, Turkey

    Murat Altunok & Erdem Cankaya

  3. Department of Nephrology, Sincan State Hospital, Ankara, Turkey

    Saliha Yildirim

  4. Department of Nephrology, Ankara Education and Research Hospital, Ankara, Turkey

    Serkan Akturk

  5. Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, 18 Mart University, Canakkale, Turkey

    Serkan Bakirdogen

  6. Department of Nephrology, Gulhane Education and Research Hospital, Ankara, Turkey

    Hadim Akoğlu & Mesudiye Bulut

  7. Department of Nephrology, Mehmet Akif Ersoy Education and Research Hospital, Sanliurfa, Turkey

    Tuncay Sahutoglu

  8. Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Ege University, Izmir, Turkey

    Mehmet Ozkahya

  9. Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey

    Yener Koc

  10. Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Afyonkarahisar Health Science University, Afyon, Turkey

    Onur Tunca

  11. Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey

    Ekrem Kara

  12. Department of Nephrology, Harakani State Hospital, Kars, Turkey

    Müge Erek

  13. Department of Nephrology, Nevsehir State Hospital, Nevsehir, Turkey

    Mehmet Polat

  14. Department of Nephrology, Giresun Education and Research Hospital, Giresun, Turkey

    Tulin Akagun

  15. Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Gazi University, Ankara, Turkey

    Galip Guz

Authors
  1. Hasan Haci Yeter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Murat Altunok
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Erdem Cankaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Saliha Yildirim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Serkan Akturk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Serkan Bakirdogen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hadim Akoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mesudiye Bulut
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tuncay Sahutoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Arda Erdut
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mehmet Ozkahya
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yener Koc
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Onur Tunca
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Ekrem Kara
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Müge Erek
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Mehmet Polat
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Tulin Akagun
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Galip Guz
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Hasan Haci Yeter: study design, writing, analysis. Murat Altunok: data collection. Erdem Cankaya: mentor of study design, critical review and paper correction. Saliha Yildirim: resource, data collection, study design. Serkan Akturk: data collection, study design. Serkan Bakirdogen: data collection. Hadim Akoglu: data collection, study design. Mesudiye Bulut: data collection. Tuncay Sahutoglu: data collection. Arda Erdut: data collection. Mehmet Ozkahya: data collection. Yener Koc: data collection. Onur Tunca: data collection. Ekrem Kara: data collection. Müge Erek: data collection. Mehmet Polat: data collection. Tulin Akagun: data collection. Galip Guz: mentor of study design, critical review and paper correction.

Corresponding author

Correspondence to Hasan Haci Yeter.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

The design and procedures of the study were approved by the Ethics Committee of the University and Turkish Pharmaceuticals and Medical Devices Agency in agreement with the principles of the Declaration of Helsinki and ethical standards for human experimentation (Date:18/04/2022, No:331/Date: 08/09/2022 No: 88521274, respectively).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yeter, H.H., Altunok, M., Cankaya, E. et al. Effects of incremental peritoneal dialysis with low glucose-degradation product neutral pH solution on clinical outcomes. Int Urol Nephrol (2024). https://doi.org/10.1007/s11255-024-04077-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11255-024-04077-7

Keywords

Search

Navigation