title: Incremental peritoneal dialysis: a 10 year single-centre experience.
abstract: BACKGROUND
  Incremental dialysis consists in prescribing a dialysis dose aimed towards maintaining total solute clearance (renal + dialysis) near the targets set by guidelines. Incremental peritoneal dialysis (incrPD) is defined as one or two dwell-times per day on CAPD, whereas standard peritoneal dialysis (stPD) consists in three-four dwell-times per day.
  
  
  METHODS
  Single-centre cohort study. Enrollement period: January 2002-December 2007; end of follow up (FU): December 2012.
  
  
  METHODS
  incident patients with FU ≥6 months, initial residual renal function (RRF) 3-10 ml/min/1.73 sqm BSA, renal indication for PD.
  
  
  RESULTS
  Median incrPD duration was 17 months (I-III Q: 10; 30). There were no statistically significant differences between 29 patients on incrPD and 76 on stPD regarding: clinical, demographic and anthropometric characteristics at the beginning of treatment, adequacy indices, peritonitis-free survival (peritonitis incidence: 1/135 months-patients in incrPD vs. 1/52 months-patients in stPD) and patient survival. During the first 6 months, RRF remained stable in incrPD (6.20 ± 2.02 vs. 6.08 ± 1.47 ml/min/1.73 sqm BSA; p = 0.792) whereas it decreased in stPD (4.48 ± 2.12 vs. 5.61 ± 1.49; p < 0.001). Patient survival was affected negatively by ischemic cardiopathy (HR: 4.269; p < 0.001), peripheral and cerebral vascular disease (H2.842; p = 0.006) and cirrhosis (2.982; p = 0.032) and positively by urine output (0.392; p = 0.034). Hospitalization rates were significantly lower in incrPD (p = 0.021). Eight of 29 incrPD patients were transplanted before reaching full dose treatment.
  
  
  CONCLUSIONS
  IncrPD is a safe modality to start PD; compared to stPD, it shows similar survival rates, significantly less hospitalization, a trend towards lower peritonitis incidence and slower reduction of renal function.
authors: O.U. of Nephrology, A.S.S.T. Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy. sandrinimassy@libero.it.
authors: Massimo
authors: http://orcid.org/0000-0001-7857-2429
authors: M
authors: Sandrini
authors: O.U. of Nephrology, A.S.S.T. Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
authors: Valerio
authors: V
authors: Vizzardi
authors: O.U. of Nephrology, A.S.S.T. Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
authors: Francesca
authors: F
authors: Valerio
authors: Università di Brescia, Brescia, Italy.
authors: Sara
authors: S
authors: Ravera
authors: O.U. of Nephrology, A.S.S.T. Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
authors: Luigi
authors: L
authors: Manili
authors: O.U. of Nephrology, A.S.S.T. Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.|Università di Brescia, Brescia, Italy.
authors: Roberto
authors: R
authors: Zubani
authors: Università di Brescia, Brescia, Italy.
authors: Bernardo J A
authors: BJ
authors: Lucca
authors: O.U. of Nephrology, A.S.S.T. Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.|Università di Brescia, Brescia, Italy.
authors: Giovanni
authors: G
authors: Cancarini
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010538:Peritonitis / Q000209:etiology; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Dialysis adequacy; Incremental dialysis; Peritoneal dialysis; Residual renal function