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Incremental peritoneal dialysis and survival outcomes: a propensity-matched cohort study

  • Original Article
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Abstract

Background

The advantages of an incremental dialysis start are not fully clear. We aimed to evaluate the association of incremental initiation of peritoneal dialysis with mortality.

Methods

Incident peritoneal dialysis patients with a catheter placed at our hospital between 2008 and 2017 were included. All patients were followed up until December 31, 2019. Patients were categorized into different groups according to the initial daily dialysis exchanges, and were matched at a ratio of 1:2 with propensity score matching. Multiple variables including age, sex, residual kidney function, urine volume, hemoglobin, serum albumin and other important variables were included for the matching. Primary outcomes were all-cause and cardiovascular mortality.

Results

A total of 1315 patients with a mean age of 45.9 years were enrolled. The mean glomerular filtration rate was 4.32 ml/min/1.73 m2 at start of dialysis. Two hundred eighty-five patients in the incremental group and 502 in the full dose group were matched for age, sex, residual kidney function, urine volume, hemoglobin, serum albumin and other important variables. Patient survival and cardiovascular event-free survival were similar between the two groups. However, during the first 6 years of peritoneal dialysis, patients in the incremental group had better survival (P = 0.011) and cardiovascular event-free survival (P = 0.044) than the full dose group, while such advantages disappeared when dialysis vintage became longer. Further analysis showed that the incremental group (vs full dose dialysis) had a 39% lower risk (95% CI 0.42–0.90, P = 0.012) of all-cause mortality and a 41% decreased risk (95% CI 0.35–0.99, P = 0.047) of cardiovascular mortality during the first 6 years of dialysis. Additionally, the cumulative hazard for anuria was significantly lower in the incremental group versus the full dose group (P = 0.006).

Conclusions

Our study shows a time-related survival advantage for incremental peritoneal dialysis patients, suggesting that an incremental regimen for starting peritoneal dialysis is feasible and is not associated with worse outcomes.

Graphical abstract

Graphical Abstract presenting schematically the measurements of the solvation response function by processing the relevant streak camera images and the time-correlated photon counting (TCSPC) data and appropriately combining them together.

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Data availability statement

All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.

References

  1. Thomas B, Wulf S, Bikbov B, Perico N, Cortinovis M, Courville de Vaccaro K et al (2015) Maintenance dialysis throughout the world in years 1990 and 2010. J Am Soc Nephrol 26:2621–2633. https://doi.org/10.1681/asn.2014101017

    Article  PubMed  PubMed Central  Google Scholar 

  2. Brown EA, Blake PG, Boudville N, Davies S, Arteaga Jd, Dong J et al (2020) International Society for Peritoneal Dialysis practice recommendations: prescribing high-quality goal-directed peritoneal dialysis. Perit Dial Int 40:244–253. https://doi.org/10.1177/0896860819895364

    Article  PubMed  Google Scholar 

  3. Auguste BL, Bargman JM (2022) Peritoneal dialysis prescription and adequacy in clinical practice: core curriculum 2023. Am J Kidney Dis. https://doi.org/10.1053/j.ajkd.2022.07.004

    Article  PubMed  Google Scholar 

  4. Reddy YNV, Mendu ML (2020) The role of incremental peritoneal dialysis in the era of the advancing American kidney health initiative. Clin J Am Soc Nephrol 15:1835–1837. https://doi.org/10.2215/cjn.03960320

    Article  PubMed  PubMed Central  Google Scholar 

  5. Neri L, Viglino G, Cappelletti A, Gandolfo C, Barbieri S (2003) Incremental dialysis with automated peritoneal dialysis. Adv Perit Dial 19:93–96

    PubMed  Google Scholar 

  6. Lee Y, Chung SW, Park S, Ryu H, Lee H, Kim DK et al (2019) Incremental peritoneal dialysis may be beneficial for preserving residual renal function compared to full-dose peritoneal dialysis. Sci Rep 9:10105. https://doi.org/10.1038/s41598-019-46654-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Sandrini M, Vizzardi V, Valerio F, Ravera S, Manili L, Zubani R et al (2016) Incremental peritoneal dialysis: a 10 year single-centre experience. J Nephrol 29:871–879. https://doi.org/10.1007/s40620-016-0344-z

    Article  PubMed  PubMed Central  Google Scholar 

  8. Blake PG, Dong J, Davies SJ (2020) Incremental peritoneal dialysis. Perit Dial Int 40:320–326. https://doi.org/10.1177/0896860819895362

    Article  PubMed  Google Scholar 

  9. Ankawi GA, Woodcock NI, Jain AK, Garg AX, Blake PG (2016) The use of incremental peritoneal dialysis in a large contemporary peritoneal dialysis program. Can J Kidney Health Dis 3:2054358116679131. https://doi.org/10.1177/2054358116679131

    Article  PubMed  PubMed Central  Google Scholar 

  10. Park JI, Park JT, Kim YL, Kang SW, Yang CW, Kim NH et al (2017) Comparison of outcomes between the incremental and thrice-weekly initiation of hemodialysis: a propensity-matched study of a prospective cohort in Korea. Nephrol Dial Transplant 32:355–363. https://doi.org/10.1093/ndt/gfw332

    Article  CAS  PubMed  Google Scholar 

  11. Obi Y, Streja E, Rhee CM, Ravel V, Amin AN, Cupisti A et al (2016) Incremental hemodialysis, residual kidney function, and mortality risk in incident dialysis patients: a cohort study. Am J Kidney Dis 68:256–265. https://doi.org/10.1053/j.ajkd.2016.01.008

    Article  PubMed  PubMed Central  Google Scholar 

  12. Roggeri A, Roggeri DP, Zocchetti C, Bersani M, Conte F (2017) Healthcare costs of the progression of chronic kidney disease and different dialysis techniques estimated through administrative database analysis. J Nephrol 30:263–269. https://doi.org/10.1007/s40620-016-0291-8

    Article  PubMed  Google Scholar 

  13. Domenici A, Comunian MC, Fazzari L, Sivo F, Dinnella A, Della Grotta B et al (2011) Incremental peritoneal dialysis favourably compares with hemodialysis as a bridge to renal transplantation. Int J Nephrol 2011:204216. https://doi.org/10.4061/2011/204216

    Article  PubMed  PubMed Central  Google Scholar 

  14. Szeto CC, Lai KN, Yu AW, Leung CB, Ho KK, Mak TW et al (1997) Dialysis adequacy of Asian patients receiving small volume continuous ambulatory peritoneal dialysis. Int J Artif Organs 20:428–435

    Article  CAS  PubMed  Google Scholar 

  15. Yan H, Fang W, Lin A, Cao L, Ni Z, Qian J (2017) Three versus 4 daily exchanges and residual kidney function decline in incident CAPD patients: a randomized controlled trial. Am J Kidney Dis 69:506–513. https://doi.org/10.1053/j.ajkd.2016.08.019

    Article  PubMed  Google Scholar 

  16. Neri L, Viglino G, Marinangeli G, Rocca AR, Laudon A, Ragusa A et al (2017) Incremental start to PD as experienced in Italy: results of censuses carried out from 2005 to 2014. J Nephrol 30:593–599. https://doi.org/10.1007/s40620-017-0403-0

    Article  PubMed  Google Scholar 

  17. Navaratnarajah A, Clemenger M, McGrory J, Hisole N, Chelapurath T, Corbett RW et al (2021) Flexibility in peritoneal dialysis prescription: Impact on technique survival. Perit Dial Int 41:49–56. https://doi.org/10.1177/0896860820911521

    Article  CAS  PubMed  Google Scholar 

  18. Yan H, Abreu Z, Bargman JM (2021) Incremental peritoneal dialysis in incident end-stage kidney disease patients. Perit Dial Int. https://doi.org/10.1177/08968608211036796

    Article  PubMed  Google Scholar 

  19. Kalantar-Zadeh K, Li PK, Tantisattamo E, Kumaraswami L, Liakopoulos V, Lui SF et al (2021) Living well with kidney disease by patient and care-partner empowerment: kidney health for everyone everywhere. Can J Kidney Health Dis 8:2054358121995276. https://doi.org/10.1177/2054358121995276

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bargman JM (2016) We use Kt/V urea as a measure of adequacy of peritoneal dialysis. Semin Dial 29:258–259. https://doi.org/10.1111/sdi.12504

    Article  PubMed  Google Scholar 

  21. Liu X, Guo Q, Feng X, Wang J, Wu J, Mao H et al (2014) Alkaline phosphatase and mortality in patients on peritoneal dialysis. Clin J Am Soc Nephrol 9:771–778. https://doi.org/10.2215/cjn.08280813

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Wu H, Huang R, Yi C, Wu J, Guo Q, Zhou Q et al (2016) Risk factors for early-onset peritonitis in southern Chinese peritoneal dialysis patients. Perit Dial Int 36:640–646. https://doi.org/10.3747/pdi.2015.00203

    Article  PubMed  PubMed Central  Google Scholar 

  23. Li PK, Szeto CC, Piraino B, Bernardini J, Figueiredo AE, Gupta A et al (2010) Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 30:393–423. https://doi.org/10.3747/pdi.2010.00049

    Article  PubMed  Google Scholar 

  24. PC A, (2009) Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28:3083–3107. https://doi.org/10.1002/sim.3697

    Article  Google Scholar 

  25. Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399–424. https://doi.org/10.1080/00273171.2011.568786

    Article  Google Scholar 

  26. Burkart JM, Satko SG (2000) Incremental initiation of dialysis: one center’s experience over a 2-year period. Perit Dial Int 20:418–422

    Article  CAS  PubMed  Google Scholar 

  27. Rosansky SJ, Cancarini G, Clark WF, Eggers P, Germaine M, Glassock R et al (2013) Dialysis initiation: what’s the rush? Semin Dial 26:650–657. https://doi.org/10.1111/sdi.12134

    Article  PubMed  Google Scholar 

  28. Rosansky SJ, Clark WF, Eggers P, Glassock RJ (2009) Initiation of dialysis at higher GFRs: is the apparent rising tide of early dialysis harmful or helpful? Kidney Int 76:257–261. https://doi.org/10.1038/ki.2009.161

    Article  PubMed  Google Scholar 

  29. Huang LL, Mah JY, Howard J, Roberts MA, McMahon LP (2021) Incremental peritoneal dialysis is a safe and feasible prescription in incident patients with preserved residual kidney function. Nephrology (Carlton). https://doi.org/10.1111/nep.13962

    Article  PubMed  Google Scholar 

  30. Li PKT, Ma TKW (2017) Global impact of nephropathies. Nephrology 22:9–13. https://doi.org/10.1111/nep.13146

    Article  PubMed  Google Scholar 

  31. Auguste BL, Bargman JM (2018) Incremental peritoneal dialysis: new ideas about an old approach. Semin Dial 31:445–448. https://doi.org/10.1111/sdi.12712

    Article  PubMed  Google Scholar 

  32. Jeloka T, Sanwaria P, Chaudhari L, Periera A (2013) “Ico-Alone” single nocturnal exchange to initiate peritoneal dialysis in patients with residual renal function-five year, single centre experience. Indian J Nephrol 23:276–279. https://doi.org/10.4103/0971-4065.114496

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Bargman JM, Thorpe KE, Churchill DN (2001) Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. J Am Soc Nephrol 12:2158–2162. https://doi.org/10.1681/asn.V12102158

    Article  PubMed  Google Scholar 

  34. Htay H, Cho Y, Pascoe EM, Darssan D, Hawley C, Johnson DW (2017) Predictors of residual renal function decline in peritoneal dialysis patients: the balANZ Trial. Perit Dial Int 37:283–289. https://doi.org/10.3747/pdi.2016.00206

    Article  PubMed  Google Scholar 

  35. Lee MJ, Park JT, Park KS, Kwon YE, Oh HJ, Yoo TH et al (2017) Prognostic value of residual urine volume, GFR by 24-hour urine collection, and eGFR in patients receiving dialysis. Clin J Am Soc Nephrol 12:426–434. https://doi.org/10.2215/CJN.05520516

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Garofalo C, Borrelli S, De Stefano T, Provenzano M, Andreucci M, Cabiddu G et al (2019) Incremental dialysis in ESRD: systematic review and meta-analysis. J Nephrol. https://doi.org/10.1007/s40620-018-00577-9

    Article  PubMed  Google Scholar 

  37. Schwenger V, Morath C, Salava A, Amann K, Seregin Y, Deppisch R et al (2006) Damage to the peritoneal membrane by glucose degradation products is mediated by the receptor for advanced glycation end-products. J Am Soc Nephrol 17:199–207. https://doi.org/10.1681/asn.2005020155

    Article  CAS  PubMed  Google Scholar 

  38. Yu X, Yang X (2015) Peritoneal dialysis in China: meeting the challenge of chronic kidney failure. Am J Kidney Dis 65:147–151. https://doi.org/10.1053/j.ajkd.2014.08.023

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank all nephrologists and nurses in our PD center for their excellent management of PD patients and maintenance of PD database. We also thank Richard Robins, PhD, from Liwen Bianji, Edanz Editing China (www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.

Funding

This work was supported by the Guangdong Basic and Applied Basic Research Foundation (Grant no. 2019A1515011775), Guangdong Provincial Key Laboratory of Nephrology (Grant no. 2020B1212060028) and NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University).

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Author notes

  1. Ruihua Liu and Hongjian Ye contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China

    Ruihua Liu, Hongjian Ye, Yuan Peng, Chunyan Yi, Jianxiong Lin, Haishan Wu, Xiangwen Diao, Haiping Mao, Fengxian Huang & Xiao Yang

  2. NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, 510080, China

    Ruihua Liu, Hongjian Ye, Yuan Peng, Haishan Wu, Xiangwen Diao, Haiping Mao, Fengxian Huang & Xiao Yang

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Contributions

XY proposed the concept of the study. RL and HY analyzed and interpreted the data. RL and HY wrote the draft of the article and revised it under the supervision of Professor XY. XY was responsible for the management of PD center and set up of PD database. XY, HM, FH and HY were in charge of the treatment of PD patients. RL, YP, JL and CY collected the data. YP, HW and XD provided intellectual content of critical importance to the work described. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Xiao Yang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study protocol was reviewed and approved by the Ethics Committee of the First Affiliated Hospital, Sun Yat-sen University, approval number ([2016]215).

Informed consent

All patients signed a written informed consent when they catheterized at our hospital, agreeing that their clinical information would be used for non-commercial scientific research.

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Liu, R., Ye, H., Peng, Y. et al. Incremental peritoneal dialysis and survival outcomes: a propensity-matched cohort study. J Nephrol 36, 1907–1919 (2023). https://doi.org/10.1007/s40620-023-01735-4

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