Improving Outcomes in Chronic Hemodialysis Patients: Should Dialysis be Initiated Earlier?

Preliminary Evaluation of Incremental Peritoneal Dialysis in 25 Patients

Background

Incremental dialysis has been suggested for patients with some residual renal function. However, very little published clinical data exist on the feasibility of this schedule.

Objectives

To assess feasibility of incremental dialysis, with regard to its effect, complications, and impact on quality of life.

Design

Pilot prospective study, not controlled.

Setting

Nephrology division, public clinical research hospital.

Patients

Twenty-five patients (19 men, mean age 61 ± 13 years, body weight 63 ± 11 kg) began peritoneal dialysis (the first treatment of uremia) with a single nightly exchange lasting 10 hours or 2 daily exchanges over 12 hours according to creatinine clearance and Kt/V. Patients gave informed consent and reported their work activity, degree of rehabilitation, and their quality of life by answering a questionnaire prepared for this purpose.

Outcome Measures

Survival rate, complications related to peritoneal dialysis, and residual renal and peritoneal clearances.

Results

During the study period no patient died. Complications related to dialysis were peritonitis (0.41 episodes/year) and exit-site infection (0.32 episodes/year). All patients continued to work with full rehabilitation and considered 1 or 2 exchanges per day less troublesome than 3 or 4.

Conclusions

Incremental dialysis is well accepted by patients and staff. This technique does not involve a high risk of complications and is economical. Therefore incremental dialysis is feasible.