Division of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy.
Department of Clinical Sciences and Community Health, Università degli studi di Milano, Milan, Italy.
J Nephrol. 2023 Mar;36(2):263-273. doi: 10.1007/s40620-022-01433-7. Epub 2022 Sep 20.
Incremental peritoneal dialysis (incPD) as the initial PD strategy represents a convenient and resource-sparing approach, but its impact on patient, healthcare and environment has not been thoroughly evaluated.
This study includes 147 patients who started incPD at our institution between 1st January, 2009 and 31st December, 2021. Adequacy measures, peritoneal permeability parameters, peritonitis episodes, hospitalizations and increase in CAPD dose prescriptions were recorded. The savings related to cost, patient glucose exposure, time needed to perform dialysis, plastic waste, and water usage were compared to full-dose PD treatment.
During the study follow-up 11.9% of the patients transitioned from incremental to full dose PD. Patient cumulative probability of remaining on PD at 12, 24, 36, 48 and 60 months was 87.6, 65.4, 46.1, 30.1 and 17.5%, respectively. The median transition time from 1 to 2 exchanges, from 2 to 3 and 3 to 4 exchanges were 5, 9 and 11.8 months, respectively. Compared to full dose PD, 1, 2, and 3 exchanges per day led to reduction in glucose exposure of 20.4, 14.8 or 8.3 kg/patient-year, free lifetime gain of 18.1, 13.1 or 7.4 day/patient-year, a decrease in cost of 8700, 6300 or 3540 €/patient-year, a reduction in plastic waste of 139.2, 100.8 or 56.6 kg/patient-year, and a decline in water use of 25,056, 18,144 or 10,196 L/patient-year.
In comparison with full-dose PD, incPD allows to reduce the time spent for managing dialysis, glucose exposure, economic cost, plastic waste, and water consumption.
增量腹膜透析（incPD）作为初始 PD 策略代表了一种方便且节省资源的方法，但它对患者、医疗保健和环境的影响尚未得到彻底评估。
本研究纳入了 2009 年 1 月 1 日至 2021 年 12 月 31 日期间在我院开始 incPD 的 147 名患者。记录了充足性测量、腹膜通透性参数、腹膜炎发作、住院和增加 CAPD 剂量处方等数据。与全剂量 PD 治疗相比，比较了成本、患者葡萄糖暴露、透析所需时间、塑料废物和用水量的节省情况。
在研究随访期间，有 11.9%的患者从增量 PD 转为全剂量 PD。患者在 12、24、36、48 和 60 个月时继续接受 PD 治疗的累积概率分别为 87.6%、65.4%、46.1%、30.1%和 17.5%。从 1 次到 2 次、从 2 次到 3 次和从 3 次到 4 次交换的中位转换时间分别为 5、9 和 11.8 个月。与全剂量 PD 相比，每天进行 1、2 和 3 次交换可分别减少 20.4、14.8 或 8.3kg/患者年的葡萄糖暴露，自由终生增加 18.1、13.1 或 7.4 天/患者年，降低 8700、6300 或 3540 欧元/患者年的成本，减少 139.2、100.8 或 56.6kg/患者年的塑料废物，并减少 25056、18144 或 10196L/患者年的用水量。
与全剂量 PD 相比，incPD 可减少管理透析、葡萄糖暴露、经济成本、塑料废物和用水量所花费的时间。
