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    Effects of incremental peritoneal dialysis with low glucose-degradation product neutral pH solution on clinical outcomes
    (Springer, 2024) Yeter, Hasan Hacı; Altunok, Murat; Çankaya, Erdem; Yıldırım, Saliha; Aktürk, Serkan; Bakırdöğen, Serkan; Akoğlu, Hadim
    Purpose Incremental peritoneal dialysis (IPD) could decrease unfavorable glucose exposure results and preserve (RKF). However, there is no standardization of dialysis prescriptions for patients undergoing IPD. We designed a prospective observational multi-center study with a standardized IPD prescription to evaluate the effect of IPD on RKF, metabolic alterations, blood pressure control, and adverse outcomes. Methods All patients used low GDP product (GDP) neutral pH solutions in both the incremental continuous ambulatory peritoneal dialysis (ICAPD) group and the retrospective standard PD (sPD) group. IPD patients started treatment with three daily exchanges five days a week. Control-group patients performed four changes per day, seven days a week. Results A total of 94 patients (47 IPD and 47 sPD) were included in this study. The small-solute clearance and mean blood pressures were similar between both groups during follow-up. The weekly mean glucose exposure was significantly higher in sPD group than IPD during the follow-up (p < 0.001). The patients with sPD required more phosphate-binding medications compared to the IPD group (p = 0.05). The rates of peritonitis, tunnel infection, and hospitalization frequencies were similar between groups. Patients in the sPD group experienced more episodes of hypervolemia compared to the IPD group (p = 0.007). The slope in RKF in the 6th month was significantly higher in the sPD group compared to the IPD group (65% vs. 95%, p = 0.001). Conclusion IPD could be a rational dialysis method and provide non-inferior dialysis adequacy compared to full-dose PD. This regimen may contribute to preserving RKF for a longer period.
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    Revolutionizing Dialysis: The Dual Impact of Incremental Peritoneal Dialysis on Patient Care and Sustainability
    (Karger, 2025) Yildirim, Saliha; Altunok, Murat; Yeter, Haci Hasan; Bakirdogen, Serkan; Cankaya, Erdem; Guz, Galip
    Introduction: Chronic kidney disease (CKD) significantly impacts global health, with dialysis patients often experiencing reduced quality of life. Incremental start peritoneal dialysis (INPD) has emerged as a promising individualized treatment strategy, offering potential benefits for both patient outcomes and environmental sustainability compared to the standard peritoneal dialysis (STPD). This study aimed to evaluate the impact of incremental start continuous ambulatory peritoneal dialysis (CAPD) on quality of life, clinical outcomes, and environmental metrics, such as plastic waste generation, compared to conventional CAPD. Methods: A multicenter study involving two groups (incremental start CAPD - INPD and standard dose conventional CAPD - STPD groups) was conducted. The baseline and 6-month follow-up data were collected, including laboratory parameters, treatment-related plastic waste, glucose load, residual renal function, and quality of life assessed using the Kidney Disease Quality Of Life Short Form (KDQOL-SF). Results: There was no statistically significant difference in median age and gender between the two groups (p > 0.05). In the third month of the study, a significant difference was observed in peritoneal equilibrium test ultrafiltration volume, with higher values in the STPD group (p = 0.020). There were no statistically significant differences between study groups according to permeability groups (p = 0.714) or KtV (p = 0.743). In the sixth month of the study, the INPD group demonstrated significantly better residual renal function (p < 0.001) and reduced weekly polypropylene and polyvinyl chloride plastic waste (p < 0.001) and glucose load (p < 0.001) in both the baseline and sixth months of the study. KDQOL-SF scores were significantly higher in the INPD group (p < 0.001). Conclusion: INPD demonstrated superior outcomes in maintaining residual renal function, reducing treatment burden, and improving quality of life while significantly lowering environmental impact compared to STPD. These findings support the adoption of INPD as an individualized and sustainable strategy in CKD management. Further research is needed to validate these findings in larger cohorts and explore long-term outcomes.