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Incremental Peritoneal and Hemodialysis

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Nolph and Gokal's Textbook of Peritoneal Dialysis

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Abstract

Incremental dialysis (IncrD) is the practice of individualized dosing of renal replacement therapy (RRT) based on, and as a supplement to, residual kidney function (RKF). IncrD has been implemented in both peritoneal dialysis (PD) and hemodialysis (HD), more commonly in home HD than in-center HD, and offers several patient-centered and system-based advantages over a fixed dialysis prescription. The “dose” of IncrD must be routinely readjusted based on changes in the RKF and clinical conditions. On the other hand, a fixed dialysis prescription does not take RKF into consideration and is aimed to achieve a predetermined standard dialysis-only solute removal target. While IncrD offers potential benefits including preservation of RKF, lifestyle flexibility, and decreased dialysis-associated costs, certain ambiguous challenges arise. These include the monitoring and titrating of an individualized dialysis dose prescription. Also, potential uncertainties are the patient, family, and staff understanding and expectations.

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Author information

Authors and Affiliations

  1. University of California San Francisco, San Francisco, CA, USA

    Rafia I. Chaudhry

  2. University of Virginia Health System, Charlottesville, VA, USA

    Tushar Chopra

  3. Vanderbilt University Medical Center, Nashville, TN, USA

    Natalie Nesmith McCall & Thomas Golper

Authors
  1. Rafia I. Chaudhry
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  2. Tushar Chopra
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  3. Natalie Nesmith McCall
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  4. Thomas Golper
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Corresponding author

Correspondence to Rafia I. Chaudhry .

Editor information

Editors and Affiliations

  1. Nephrology, School of Medicine Department of Medicine Division of, Columbia, MO, USA

    Ramesh Khanna

  2. Dept. Medicine Div. Nephrology, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands

    Raymond T. Krediet

Glossary

APD

Automated peritoneal dialysis

CAPD

Continuous ambulatory peritoneal dialysis

Ccreat

Creatinine clearance

Curea

Urea clearance

ESRD

End-stage renal disease

GFR

Glomerular filtration rate

IDEAL

The Initiation of Dialysis of Early and Late Trial

IncrD

Incremental dialysis

KDOQI

Kidney Disease Outcomes Qualitative Initiative

Kru

Residual kidney function urea clearance

Kt/Vurea

Urea clearance times time/volume of distribution of urea (total body water)

NECOSAD

Netherlands Cooperative Study on the Adequacy of Dialysis

PDA

Peritoneal dialysis assist

RCT

Randomized controlled trial

RKF

Residual kidney function

RRT

Renal replacement therapy

UO

Urine Output

USRDS

United States Renal Data Systems

UV

Urine volume

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Chaudhry, R.I., Chopra, T., McCall, N.N., Golper, T. (2022). Incremental Peritoneal and Hemodialysis. In: Khanna, R., Krediet, R.T. (eds) Nolph and Gokal's Textbook of Peritoneal Dialysis. Springer, Cham. https://doi.org/10.1007/978-3-319-90760-4_33-1

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  • DOI: https://doi.org/10.1007/978-3-319-90760-4_33-1

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