Incremental Peritoneal Dialysis - Definition, Prescription and Clinical Outcomes

Incremental peritoneal dialysis (IPD) is a strategy of renal replacement therapy that is based on the prescription of a lower dose rather than the standard full dose of peritoneal dialysis (PD). The clearance goals are achieved through the combination of residual kidney function (RKF) and peritoneal clearance. The dialysis prescription should be increased as the RKF declines. IPD has been associated with clinical, economic, and environmental advantages. We emphasize possible better quality of life, fewer mechanical symptoms, lower costs, slight adverse metabolic effects, and lesser plastic waste and water consumption. It has also been addressed the potential benefits for RKF preservation and the lower risk of peritonitis. There are some concerns regarding this strategy, such as inadequate clearance of uremic toxins and/or severe electrolyte disturbances due to undetected loss of RKF; lower clearance of medium-sized molecules (such as beta-2-microglobulin) which mostly depends on the total PD dwell time; and patients' reluctance to dose adjustments. Current clinical evidence is based on moderate to low quality studies and suggests that the outcomes of IPD will be at least identical to those of full dose. This review aims to discuss the definition and strategies to IPD prescription, as well as its advantages and disadvantages. It'll also be reviewed the current evidence regarding this strategy.