Incremental dialysis with automated peritoneal dialysis.

Since December 2000, we have proposed incremental dialysis to our patients with a glomerular filtration rate (GFR) of 8-9 mL/min/1.73 m2. The incremental dialysis uses automated peritoneal dialysis (APD) 3-4 days per week ["low frequency APD" (LF-APD)], with or without a full abdomen during the period between the nighttime sessions. From December 1, 2000, to September 30, 2001, LF-APD was selected by 5 patients (2 men, 3 women). Of the 5 patients, 4 worked (age: 53 +/- 12 years; range: 40-69 years), and 1 (age: 78 years) needed assistance from a partner who was available only on certain days of the week. Only 1 patient had diabetic nephropathy. The LF-APD was performed by 4 patients on alternate days ("standard LF-APD"), and by 1 patient 3 times per week (owing to limited availability of the partner). At the beginning of treatment, mean nightly LF-APD was 8.9 +/- 0.9 hours with a volume of 13.4 +/- 3.1 L. In 3 patients, icodextrin was used for the dwell between subsequent APD sessions (1-1.5 L). The other 2 patients kept an empty abdomen (owing to body image). Residual renal function (RRF) was measured every 3 months; adequacy and peritoneal equilibration test (PET), every 6 months. Total nightly APD volume was modified based on the results of the PET. At December 31, 2002, 3 patients with follow-ups of 25, 22, and 15 months were still on LF-APD because their GFR had remained unchanged. In another patient, the frequency of the APD sessions was increased after 5 months to 5 times per week from 3.5 times per week following a clinical assessment of underdialysis; however, that patient had had no significant change in GFR. Following a rapid decline in the diabetic patient's GFR (to 3.6 mL/min/1.73 m2 from 7.9 mL/min/1.73 m2 in 18 months) and refusal by that patient to increase the number of days of APD, the diabetic patient was transferred to hemodialysis. No episodes of peritonitis occurred in a total LF-APD follow-up of 84 patient-months. Compliance, assessed using the HomeChoice Pro system and comparing prescribed and recorded sessions, was total (no missed treatments). In conclusion, LF-APD can be a valid form of incremental dialysis and can help patients to choose PD as their first renal replacement therapy.