Evaluation of Long‐Term Combination Therapy With Peritoneal Dialysis and Hemodialysis

Abstract

It is well known that a combination therapy with peritoneal dialysis (PD) and hemodialysis (HD) is feasible and may improve clinical status in patients for whom adequate solute and fluid removal is difficult to achieve with PD alone. The objective of the present study was to evaluate whether the therapy is useful in the likelihood of long-term peritoneal membrane and cardiac function. The therapy was 6 days of PD and one session of HD per week. Physical, biochemical, dialysate-to-plasma ratio of creatinine (D/P Cr), arteriovenous fistula (AVF) blood flow, and left ventricular mass index (LVMI) data were prospectively analyzed in 30 patients with measurements performed at 0 and 6 months, and for 21 patients, 12 or 18 months after initiation of the therapy. The levels of hemoglobin (Hb) after therapy were significantly higher than those at the initiation of therapy. The levels of LVMI and human atrial natriuretic peptide (hANP) after therapy were significantly lower than those at the initiation of therapy, whereas AVF blood flow did not change significantly. D/P Cr levels at 6 months after the therapy were significantly lower than those at the initiation of therapy. D/P Cr levels at 12 or 18 months after the therapy were not aggravated. It appears that the therapy improves Hb levels and cardiac function because of adjusting body fluid status. It was indicated that peritoneal function after therapy may be improved. Therefore, combination therapy is useful from the lifestyle viewpoint of patients in the transition period of PD to HD with end-stage kidney disease.

Health-related quality of life on combination therapy with peritoneal dialysis and hemodialysis in comparison with hemodialysis and peritoneal dialysis: A cross-sectional study

“…23 PDþHD is usually adopted to continue PD when the residual renal function (RRF) decreases and becomes insufficient to maintain adequate dialysis. [24][25][26][27][28][29] Once-weekly HD sessions are generally added to 5 to 6 days of PD to increase dialysis doses. In 2014, onefifth of Japanese PD patients were treated by PDþHD.…”

“…In particular, 40.9% of patients with a PD history of more than 6 years underwent this combination therapy. 23 Several benefits of PDþHD have been reported [24][25][26][27][28][29][30] such as improvement of uremic symptoms, hypertension, renal anemia, left ventricular mass index, peritoneal permeability, and technique survival. However, most of these results were in before-after studies on PD patients with a decreased RRF.…”

Impact of Hybrid Therapy Comprising Peritoneal Dialysis and Hemodialysis on Acute Cardiovascular Events

“…In that trial, Bertoluci et al [28] described that the improvements in cardiac end-organ damage might be associated with reductions in the long-term clinical consequences of hypertensive cardiomyopathy. According to previous reports, LVMI or SBP decreased after the initiation of hybrid therapy in PD patients [7,[9][10][11]. However, in these reports, among the echocardiographic parameters, LVEF was not improved by 9-12 months after initiation.…”

“…Hybrid therapy, which has been actively initiated for PD patients in Japanese centers since 1995 [4], improves the dialysis dose compared to PD alone [5][6][7][8] and decreases left ventricular mass index (LVMI) or systolic blood pressure (BP) after its initiation in PD patients [7,[9][10][11]. The cost of hybrid therapy has been covered by the National Health Care Insurance System in Japan since April 1, 2010.…”

Comparisons of Clinical Outcomes in Patients Transferred to Combined Therapy with Peritoneal Dialysis and Hemodialysis over those Directly Transferred to Hemodialysis: A Prospective Multicenter Study in Japan

“…Combined therapy has been covered by the National Health Care Insurance System in Japan since April 2010. Several reports have demonstrated the clinical utility of combined therapy for correction of inadequate dialysis and/or uid overload (7)(8)(9)(10)(11). We established the Evaluation of the Adequacy of Renal replacement Therapy (EARTH) study group to clarify the clinical utility of combined therapy in 2008 and published a retrospective multicenter study of 104 patients switched from PD alone to combined therapy with PD and HD (7).…”