As low as possible, as high as necessary: a patient's view of incremental PD
In CJASN's Patient Voice series, Jan van Cruchten describes starting peritoneal dialysis to protect his remaining kidney function, still making good urine more than five years in, and why the dose and the decision should be shared.
🎧 Listen: Weekly · Oct 26, from 16:15.
Who is writing
Jan van Cruchten is a kidney patient, a former chair of the Dutch Kidney Patients Association and secretary of the European Kidney Patients Federation. His essay is one person's experience, not a study. It accompanies a CJASN study of how incremental PD is prescribed, by Selwood and colleagues.
His story
He started kidney replacement therapy when his eGFR reached 9 and chose peritoneal dialysis with his nephrologist, hoping to preserve his remaining kidney function longer, with less risk of fluid restriction, no need for vascular access and a better chance of continuing to work. He began with daytime exchanges four times a day for six weeks, then moved to PD overnight. After two years and ten months he received a transplant that failed; his PD catheter had to be removed, and he had three months of in-center hemodialysis before choosing to return to PD at home, where over time he needed more fluid and longer sessions. More than five years in, he still had good urine output and no fluid restriction, and he had one episode of peritonitis. He is candid that the fifth and sixth years became much harder. After five years and four months of dialysis he received a kidney through the Acceptable Mismatch Program, and it is still functioning well.
His message
- The dose should be "as low as possible and as high as necessary."
- Monitoring has to be regular and timely; his check-ups were every six weeks.
- Less dialysis fluid also means less glucose exposure for the peritoneum.
- Shared decision-making, with realistic expectations, is essential.
Why it matters
Our take: an incremental prescription only works if someone is watching, and the decision is made together.
Funding and ties: no funding was reported.
The source: van Cruchten J. A Kidney Patient's Perspective on Incremental Peritoneal Dialysis and Shared Decision-Making. Clin J Am Soc Nephrol. Published online October 16, 2026. doi:10.2215/CJN.0000001259 Read the original
Also discussed:
- Selwood J, Shuaib R, FitzGerald TJ, et al. Evaluating patterns and outcomes in the prescription of incremental peritoneal dialysis in support of shared decision-making. Clin J Am Soc Nephrol. 2026;21(11):1959-1967. doi:10.2215/CJN.0000001187 Link
🎧 Listen: Weekly · Oct 26, from 16:15.
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