Incremental Peritoneal Dialysis May Safely Replace Standard Method for New Patients, Study Suggests

The study, published in BMC Nephrology, revealed that incremental peritoneal dialysis may be a viable alternative to SPD for new dialysis patients. The analysis indicates no significant differences in patient survival, rates of peritonitis, or technique survival between the two approaches. However, according to the authors, the effects of IPD on residual renal function (RRF) remain uncertain.

Incremental peritoneal dialysis involves administering less than the standard full-dose peritoneal dialysis for patients with end-stage renal disease. Although IPD is increasingly documented in the literature, its safety and efficacy compared to SPD remain uncertain. Therefore, Jing Cheng, Hospital HuZhou University, Huzhou, Zhejiang Province, China, and colleagues conducted a systematic review of studies that compared mortality, rates of peritonitis, technique survival, anuria-free survival, and RRF between IPD and SPD.

For this purpose, the researchers included all comparative studies published on PubMed, Embase, CENTRAL, Scopus, and Web of Science databases from their inception until September 5, 2023, that reported on the specified outcomes.

The following were the key findings of the study:

• Ten studies were included. Definitions of IPD were heterogenous and hence mostly a qualitative synthesis was undertaken.
• The majority of studies found no difference in patient survival between IPD and SPD.
• Meta-analysis of crude mortality data also presented no significant difference.
• Peritonitis and technique survival were also not significantly different between IPD and SPD in the majority of studies.
• Data on RRF was conflicting. Some studies showed that IPD was associated with the preservation of RRF, while others found no such difference.

The findings revealed that incremental peritoneal dialysis may yield outcomes similar to standard peritoneal dialysis in new dialysis patients. There appear to be no significant differences in patient survival, rates of peritonitis, or technique survival between the two approaches. However, the effect of IPD on residual renal function remains uncertain, with existing evidence being heterogeneous and conflicting.

"Future studies should include comparable groups of patients, initiating observations at the start of peritoneal dialysis. These studies should comprehensively report all outcomes covered in this review, ensuring a sufficiently long follow-up period to yield robust evidence," the researchers concluded.

The researchers, however, noted several limitations, including a limited number of studies and significant methodological differences that hindered comprehensive analysis. Many studies relied on observational data, introducing bias, and lacked clarity on patient selection. Additionally, they did not report outcomes for patients transitioning to hemodialysis or transplantation and important issues like cardiovascular diseases.

Reference:

Xu, S., Wu, W. & Cheng, J. Comparison of outcomes of incremental vs. standard peritoneal dialysis: a systematic review and meta-analysis. BMC Nephrol 25, 308 (2024). https://doi.org/10.1186/s12882-024-03669-w