Days-Off Versus Daily Initial Peritoneal Dialysis Prescription

Open to people ages 18 years and up

1. Willingness to give written informed consent prior to any study-related procedures being performed.
2. End-stage kidney disease, with first maintenance dialysis (PD or HD) initiated within 120 days prior to randomization.
3. Home PD initiated within 30 days prior to randomization, defined as first PD exchange performed at home following completion of PD training.
4. Residual kidney function, measured on a clinically obtained 24-hour urine collection within 45 days prior to randomization, demonstrating both (a) urine volume ≥500mL/24 hours and (b) urine clearance (mean of urea and creatinine clearance) ≥6 to <12 L/min/1.73m2
5. In the judgment of the treating nephrologist, expected to remain on PD for at least 6 months following randomization
6. Expected to receive ongoing PD care at the study enrollment site for the duration of study follow-up.
7. Willingness to accept either randomized treatment assignment, adhere to the treatment schedule, and adhere to protocol schedule of activities.
8. Sufficient fluency in English or Spanish to understand study materials and complete study assessments.

1. A laboratory-documented decline of ≥50% in residual kidney function (24-hour urine volume or mean of urea and creatinine clearance) since initiation of maintenance dialysis (HD or PD).
2. Initiated maintenance dialysis due to kidney transplant failure.
3. During the run-in period, requirement of either of the following for clinical purposes: (a) 7-day-per-week PD prescription or (b) a daytime dwell, if receiving automated peritoneal dialysis (APD).
4. Any other condition that, in the judgment of the investigator, would make the participant unsuitable for days-off PD for at least 6 months following randomization.
5. Concurrent participation in another interventional clinical trial.
6. Known pregnancy or nursing at the time of screening, or of child-bearing potential and planning for possible pregnancy during the study period.
7. Any condition that, in the judgment of the investigator, would make the participant unsuitable for the study or preclude participation for at least 6 months following randomization (e.g., anticipated kidney transplantation, anticipated transfer of dialysis care outside a participating study site, life expectancy <6 months, or other significant medical, psychiatric, or social circumstances).