Worldwide Experience with Incremental Peritoneal Dialysis

Although much has been published about the adequacy of dialysis and the effect of dialysis dose on morbidity and mortality in peritoneal dialysis patients, much less is known about when dialysis should be initiated. There are several advantages of using peritoneal dialysis for “early start” dialysis compared to hemodialysis, including lifestyle, diet and cost benefits. Several small studies on incremental peritoneal dialysis are reviewed in this article, and they provide conflicting results with regard to patient morbidity and mortality. In addition, there are peritoneal dialysis-related risks to incremental dialysis, including peritonitis, hernias and catheter-related complications. Since none of these studies were performed using a randomized cohort, it is unclear how selection bias and study design may have influenced the results reported. A large randomized trial of “early start” versus “standard start” dialysis is needed to help determine the potential risks and benefits of incremental peritoneal dialysis. Such a study is presently underway in Australia and New Zealand, and results from this study should be available in 2008.