Supplementary Material for: Revolutionizing Dialysis: The Dual Impact of Incremental Peritoneal Dialysis on Patient Care and Sustainability

Introduction: Chronic kidney disease (CKD) significantly impacts global health, with dialysis patients often experiencing reduced quality of life. Incremental start peritoneal dialysis has emerged as a promising individualized treatment strategy, offering potential benefits for both patient outcomes and environmental sustainability compared to standard peritoneal dialysis. This study aimed to evaluate the impact of incremental start continuous ambulatory peritoneal dialysis (CAPD) on quality of life, clinical outcomes, and environmental metrics, such as plastic waste generation, compared to conventional CAPD. Methods: A multicenter study involving two groups (incremental start CAPD—INPD and standard dose conventional CAPD—STPD groups) was conducted. Baseline and six-month follow-up data were collected, including laboratory parameters, treatment-related plastic waste, glucose load, residual renal function, and quality of life assessed using the Kidney disease quality of life short form (KDQOL-SF). Results: There was no statistically significant difference in median age and gender between the two groups (p>0.05). In the third month of the study, a significant difference was observed in PET ultrafiltration volume, with higher values in the STPD group (p=0.020). There were no statistically significant differences between study groups according to permeability groups (p=0.714) or KtV (p=0.743). In the sixth month of the study, the INPD group demonstrated significantly better residual renal function (p<0.001) and reduced weekly polyprolene and polyvinile chloride plastic waste ( p<0.001) and glucose load (p<0.001) in both the baseline and sixth months of the study. KDQOL-SF scores were significantly higher in the INPD group (p<0.001). Conclusion: INPDD demonstrated superior outcomes in maintaining residual renal function, reducing treatment burden, and improving quality of life while significantly lowering environmental impact compared to STPD. These findings support the adoption of INPD as an individualized and sustainable strategy in CKD management. Further research is needed to validate these findings in larger cohorts and explore long-term outcomes.