Current Status and Perspectives of Stepwise Initiation of Peritoneal Dialysis

In the early 1990s, Moncrief et al. introduced a novel method with subcutaneous burying of the distal segment of Moncrief-Popovich catheter 4-6 weeks prior to starting peritoneal dialysis (PD). The concept regarding stepwise initiation of PD using the Moncrief-Popovich technique (SMAP) or stepwise initiation of PD (SIPD) with embedded PD catheters has not been widely accepted. Advantages of SMAP/SIPD include enabling uncontaminated wound healing, effective immobilization of the catheter, allowing preparation of patients for PD at pre-uremic stage, prompt initiation of PD without the need for break-in period, and shorter hospital stay and improvement of patient care. However, compared with standard insertion with resting but no subcutaneous burying of the catheter, SMAP/SIPD was not associated with a significant reduction in all-cause mortality, peritonitis rate and exit-site/tunnel infection rate.