Introduction:
Nowadays incremental Peritoneal dialysis IPD become an highly acceptable modality of renal replacement therapy RRT in patients newly initiated on peritoneal dialysis PD.this modality has several advantages in particular, as the patient still has adequate residual renal function this modality may associated with better outcome
Methods:
We reported a 33 years old female patient who is known to have chronic kidney disease stage 5 due to a biopsy proven IgA nephropathy. She is active young worker female ultimately she developed uremic symptom . However she still making adequate urine out put between 500 and 800 ml per day .we discussed with her the options of RRT initially she was reluctant and refused all modality of RRT .but later with proper education she gareed to start on PD .
Subsequently peritoneal catheter inserted and she was trained on PD at our unit as per program protocol. We started her on IPD ,nocturnal automated PD 3 times per week gentle PD prescription with low number of cycles and lower total volume .a follow up showed her uremic symptoms improved and her laboratory tests were with accepted level.
She performed her daily activities including her regular work schedule .and more importantly she accepted the PD as modality of RRT and become part of her life without affecting her daily busy schedule with balanced and good life quality.
Results:
The main concept of intermittent PD based on the prescription of a lower dose rather than the standard full dose of peritoneal dialysis (PD). The lower dose means less number of cycles ,less volume and decrease number of the days per week like every other day. as the patient has good residual renal function RRF the clearance is achieved by combination of both IPD and RRF. however by the time there will be decline and loss of RRF hence the prescription needs to be increased and optimised to meet the adequate clearance.
There is multiple benefits and advantages with IPD one of most important point is maintain of RRF and delay the progression of loss of renal function and that will translate to better outcome and survival benefits .
Other clinical benefit it may decrease risk of infection and peritonitis by decrease number of contact with PD catheter.
As we know its not uncommon that patients who in need of RRT to refuse initiation of RRT and in some communities accepting the concept to perform dialysis at home is difficult. Hence one of important aspect of IPD is to avoid overwhelming social status as its more convenient and flexible with social life. In IPD where the patient skip some days without dialysis this will provide more time to the patient to perform his daily activities, and taken in consideration it done at home not at hospital or hemodialysis unit this will provide more convenient time and overall this will improve quality of life .
There is also economic and environmental benefits. IPD decrease the cost as well as decrease number of disposable like plastic lines , bags and water consumption this will positively impact on the current era of climate changes.
However still there is some points needs to be considered for example there is some concerns , such as inadequate clearance of uremic toxins and/or electrolyte disturbances due to undetected loss of RKF.
Furthermore a concern about adequacy of clearance of other uremic toxin in particular large and medium molecule like B2 macroglobulin which required prolong total indwelling time for proper clearance .
other thing to consider some patient may reluctant to modify the prescription once needed in the future as RRF decline.hence patient need to be informed in advance about change of perscription in the future.
In order to achieve adequate dialysis with IPD optimal patient selection needed with full education and a through evaluation as well as frequent follow up for clinical condition and laboratory tests .
Based on current clinical evidence obtained from published studies showed that in proper seleceted patient IPD as at least similar outcomes to those with full dose PD .overall effectiveness is compatible to conventional standard PD in newly started patients on RRT .however later with loss of residual renal function modification of prescription needed toward conventional PD prescription.
Conclusions:
Conclusion
IPD is convenient modality of RRT in newly started patients on PD particularly with good RRF. it has advantage with better quality of life .and overall clinical outcome at least compatible to conventional PD .more standardized criteria needed based on RCT. dialysis program needs to encourage IPD probably as first choice for RRT .
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.