Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Hacettepe University, TR-06560, Ankara, Turkey.
Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
Int Urol Nephrol. 2024 Sep;56(9):3123-3132. doi: 10.1007/s11255-024-04077-7. Epub 2024 May 14.
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.
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.
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).
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.
增量腹膜透析（IPD）可减少葡萄糖暴露的不良结果并保留残余肾功能（RKF）。然而，对于接受 IPD 的患者，透析方案尚无标准化。我们设计了一项前瞻性观察性多中心研究，采用标准化的 IPD 处方，以评估 IPD 对 RKF、代谢改变、血压控制和不良结局的影响。
所有患者在增量持续不卧床腹膜透析（ICAPD）组和回顾性标准腹膜透析（sPD）组中均使用 GDP 中性 pH 值的低 GDP 产品。IPD 患者开始每周 5 天每天 3 次治疗。对照组患者每天进行 4 次交换，每周 7 天。
本研究共纳入 94 例患者（47 例 IPD 和 47 例 sPD）。在随访期间，两组的小分子清除率和平均血压相似。在随访期间，sPD 组的每周平均葡萄糖暴露量明显高于 IPD 组（p<0.001）。与 IPD 组相比，sPD 组的患者需要更多的磷结合药物（p=0.05）。两组腹膜炎、隧道感染和住院频率的发生率相似。与 IPD 组相比，sPD 组的患者发生更多的高容量血症发作（p=0.007）。与 IPD 组相比，sPD 组的 RKF 斜率在第 6 个月时显著更高（65%对 95%，p=0.001）。
IPD 可能是一种合理的透析方法，与全剂量 PD 相比提供非劣效的透析充分性。这种方案可能有助于更长时间地保留 RKF。
