{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:55:14Z","timestamp":1790780114727,"version":"4.1.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"abstract":"\n Key Points<\/jats:title>\n \n \n \n Most people on incremental peritoneal dialysis did not require changes to their starting prescription within the first 12 months.<\/jats:p>\n <\/jats:list-item>\n \n Age, male sex, and lower serum albumin at dialysis start were associated with the timing of dialysis prescription increments.<\/jats:p>\n <\/jats:list-item>\n \n Low rates of transfer to hemodialysis and death rates confirmed the safety of incremental peritoneal dialysis regimens.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Introduction<\/jats:title>\n Incremental peritoneal dialysis (PD), where less than full-dose prescriptions are increased as residual kidney function declines, contributes to increased quality of life and reduced dialysis burden. Evidence supporting the safety of incremental regimens and informing patient expectations is limited. This study examined time to increment in dialysis prescriptions, PD modality transfer, transfer to hemodialysis, and mortality rates within a single center delivering incremental PD.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients incident to PD and on incremental regimens were followed for changes in prescription, modality transfer, and death between January 1, 2012, and December 31, 2023. Multivariable Cox regression assessed factors associated with time to increment, and Kaplan\u2013Meier methods with log-rank testing were used for time-to-event analyses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The cohort included 527 patients. At 1 year, 64% (95% confidence interval [CI], 60% to 69%) remained on the same starting regimen, with 36% of people (95% CI, 31% to 41%) having not incremented by 2 years. Time to increment was shorter for younger age at PD start (per decade, hazard ratio [HR], 0.92; 95% CI, 0.85 to 0.99;\n P<\/jats:italic>\n = 0.02), male sex (HR, 1.67; 95% CI, 1.29 to 2.16;\n P<\/jats:italic>\n < 0.001), and lower serum albumin (HR, 0.96; 95% CI, 0.94 to 0.98;\n P<\/jats:italic>\n < 0.001). PD modality transfer was driven by lifestyle, fluid overload, and uremic symptoms. Transfer to hemodialysis was associated with younger age (\n P<\/jats:italic>\n = 0.03) and diabetes mellitus (\n P<\/jats:italic>\n = 0.04), while time to hemodialysis transfer was correlated with lower albumin (\n P<\/jats:italic>\n = 0.01) and starting eGFR (\n P<\/jats:italic>\n = 0.006). Mortality rates were low at 0.11 events per person-year.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Younger age, male sex, and lower albumin at dialysis start are associated with a shorter time to increment. Low rates of transfer to hemodialysis and death rates in this cohort support the safety of incremental PD prescribing. A simple clinical score was subsequently constructed and tested as a method of supporting shared decision making and informing patient expectations of treatment, but requires validation in future studies.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.0000001187","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T16:01:13Z","timestamp":1787673673000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating Patterns and Outcomes in the Prescription of Incremental Peritoneal Dialysis in Support of Shared Decision Making"],"prefix":"10.2215","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4909-0177","authenticated-orcid":false,"given":"Jessica","family":"Selwood","sequence":"first","affiliation":[{"name":"Department of Renal Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom"},{"name":"Department of Immunology and Inflammation, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2316-9798","authenticated-orcid":false,"given":"Rishana","family":"Shuaib","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ted J.","family":"FitzGerald","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Punzalan","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8790-9927","authenticated-orcid":false,"given":"Gaetano","family":"Lucisano","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4453-6486","authenticated-orcid":false,"given":"Edwina A.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom"},{"name":"Department of Immunology and Inflammation, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4607-8554","authenticated-orcid":false,"given":"Richard W.","family":"Corbett","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Imperial 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