Hospitalization for Patients on Combination Therapy With Peritoneal Dialysis and Hemodialysis Compared With Hemodialysis

Abstract

Introduction: Combination therapy with peritoneal dialysis and hemodialysis (PDþHD) is widely used for PD patients with decreased residual kidney function in Japan; however, hospitalization for this combined dialysis has not been investigated so far. We compared the risk of hospitalization for PDþHD with that for HD. Methods: A multicenter, prospective observational study was conducted on 42 PDþHD and 42 HD patients matched for age and diabetic nephropathy. The main outcome measure was the cumulative incidence of hospitalization for any cause assessed with the Kaplan-Meier method. Hospitalization rates (the number of admissions per 100 patient-years) associated with dialysis modality were also calculated. The impact of dialysis modality on time to hospitalization was analyzed using the Cox proportional hazard model.Results: There was no significant difference between groups in terms of age, sex, dialysis vintage, diabetic nephropathy, and comorbidities. The cumulative incidence of hospitalization did not significantly differ between the groups (log-rank test, P ¼ 0.36). Although total hospitalization rates were 66.0 in PDþHD and 59.2 in HD, hospitalization rates for the sum of PD-related infections (a composite of catheter-related infection and peritonitis) and vascular access troubles were 21.7 in PDþHD and 7.2 in HD. On univariate Cox proportional hazard analysis, dialysis modality had no significant impact on time to hospitalization. Conclusion:The risk of hospitalization was not significantly different between PDþHD and HD, although PDþHD patients had a higher risk of dialysis access-related complications than HD patients.

Need for evidence on long-term prognosis of PD+HD: a commentary

“…Nevertheless, the present study provided an important finding that PD+HD had a similar prognosis to HD, which was compatible with a recent Japanese study [4]. The consistency of the results from different regions suggested the feasibility and generalizability of PD+HD.…”

“…In fact, health-related quality of life for PD+HD was close to that for PD but was better than HD in role and social functions [3]. In this cohort, hospitalization risk was similar between PD+HD and HD, although PD+HD may have a higher hospitalization risk of dialysis access-related complications than HD [4]. However, many of these findings were from low quality studies, and several important arguments, such as long-term prognosis and appropriate treatment duration, and suitable patients, have not been determined.…”

“…The flexibility may enable a smooth and appropriate transition of dialysis modality, and it may be of help during disastrous situations, such as recent COVID-19 pandemic [6]. On the other hand, dialysis access-related complications [4] and peritonitis [5] were risk factors of hospitalization for PD+HD, and technique survival rate was poor in those who required high ultrafiltration volume by additional HD [7]. It is necessary to identify suitable patients and establish the optimal indication for PD+HD.…”

Combining Peritoneal and Hemodialysis in the Same Patient: Furthering Precision Medicine in Dialysis Transitions

“…In the current edition of KI Reports, Tanaka et al 10 have investigated hospitalization outcomes in patients converted to a combination of PD and HD, a modality that is rarely heard of in the United States or Western Europe. Investigators matched prevalent HD patients with 42 combined PD and HD patients, most (37, or 88% of the combined PD-HD cohort) of whom were converted from PD due to inadequate dialysis or volume overload.…”

“…There are inherent limitations to this small, nonrandomized study from Japan, 10 including the lack of individual dialysis PD prescription details before transition and individual patient characteristics that make it difficult to ascertain if adjusting the PD prescription may have prevented them from switching to the combination modality. The small study in a limited geographical area with a homogeneous patient population will also affect generalizability of these findings to other non-Asian countries, especially because most dialysis centers around the world are not capable (logistically or otherwise) of performing such combination dialysis treatments.…”