Do you initiate peritoneal dialysis with an incremental strategy to ease patients into their treatment, even though it might lead to frequent lab monitoring and the risk of underdialysis?

The benefits of incremental peritoneal dialysis, in patients who have residual kidney function, cannot be overstated. In addition to "easing into treatment" as suggested in this question, other benefits include:

• reduced exposure to dialysate and glucose in dialysate, potentially preserving the perit...

There are excellent responses already to this question. I agree with them both. Our group's practice is also to start every patient on incremental PD as residual kidney function allows.

I prepared an answer to this question before realizing other faculty responses were provided. While my response is...

I am a huge advocate of incremental PD for all the reasons mentioned by Dr. @Dr. First Last. I will not repeat them. The only reason I might not is if I had an anuric patient that was started on PD (AKI that did not recover) and I had no choice for clearance reasons, but even then...

I pretty much start everyone on incremental PD. They’re going from a lot less clearance to additive clearance so they’re only better off than they were before it. They typically have a fair amount of residual renal function, so I’m hardly concerned about under-dialysis. It makes sense from a comfort...

There are so many reasons to start slowly and work your way up (incremental PD), with dwell size and dwell number, and even the need for last bag fill (NIPD to CCPD). Anyone needing PD (unless coming over from HD and anuric) will have plenty of RRF, or they wouldn't have survived to this point, and ...