Incremental Peritoneal Dialysis in End-Stage Kidney Disease: Impact on Dialysis Adequacy, Quality of Life, And Infectious Complications From A Tertiary Care Centre in Rural India

Abstract

Background: Incremental continuous ambulatory peritoneal dialysis (CAPD) is initiated in patients with end-stage renal disease (ESRD) who have good residual kidney function, with the aim of maintaining adequate dialysis, preserving quality of life, and reducing the risk of peritonitis. Objective: The aim of this study was to assess the adequacy of dialysis, quality of life, peritonitis rate, and clinical outcome among patients treated with an incremental CAPD regimen (two exchanges/day). Methods: We conducted a prospective observational study at a tertiary care centre between November 2023 and October 2025, enrolling twenty-five incident CAPD patients. Catheters were placed percutaneously under fluoroscopic guidance. Peritonitis episodes, dialysis adequacy (total weekly Kt/V), peritoneal equilibration test (PET) findings, and all-cause mortality were tracked, and the Medical Outcomes Study Short Form-36 (SF-36) questionnaire was administered at 12 months. Results: Of the 25 patients, 20 (80%) were men, with a mean age of 55 years; diabetes and hypertension were each present in 40%. Seven patients (28%) developed bacterial peritonitis, a rate of 0.4 episodes per patient-year. No fungal peritonitis, catheter loss, or CAPD-related death occurred. Mean total weekly Kt/V was 1.7, and 76% of patients showed high or high-average peritoneal transport on PET. SF-36 scores showed better preservation of emotional well-being (68.5) and social functioning (66.3) than physical functioning (55.4) and vitality (44.2). Overall mortality was 8%, with deaths attributable to non-dialysis causes. Conclusion: Incremental CAPD achieved satisfactory dialysis adequacy, an acceptable peritonitis rate, and reasonably preserved quality of life, with no CAPD-related deaths or technique failure of note.