[Incremental peritoneal dialysis: a common solution for different types of patients].
It is still a matter of debate whether peritoneal dialysis should be initiated with a full dose regimen or with incremental doses. The use of low-dose dialysis is not always feasible, but it may have the advantages of improved quality of life and lower infective and metabolic complication rates. However, incremental peritoneal dialysis has to meet the minimal suggested adequacy targets in terms of depuration (Kt/V, creatinine clearance), ultrafiltration, and electrolyte balance. Incremental peritoneal dialysis has been proved feasible and safe in asymptomatic patients with a glomerular filtration rate (GFR)<6 mL/min, but the residual renal function has to be monitored strictly. A second population is composed of asymptomatic, mostly older patients with GFR between 6 and 10 mL/min, in whom a low-dose start may preserve the residual renal function and favor a more gradual training. Lastly, patients with severe, terminal, chronic cardiomyopathy who are not candidates for a heart transplant may experience beneficial effects on cardiac function and hospitalization with low-dose peritoneal dialysis treatment even when they have GFR>10 mL/min. In conclusion, incremental peritoneal dialysis is a feasible therapeutic option that the nephrologist should know and be able to perform in those patients who may benefit from it.
Bertoli
Silvio V
SV
U.O. Nefrologia e Dialisi, IRCCS Multimedica Holding, Sesto San Giovanni (MI), Italy. silvio.bertoli@multimedica.it
Musetti
Claudio
C
Ciurlino
Daniele
D
D005919:Glomerular Filtration Rate; D015312:Hemodialysis Solutions / Q000008:administration & dosage; D006801:Humans; D010530:Peritoneal Dialysis / Q000379:methods*
D015312:Hemodialysis Solutions