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

Abstract

Background: The impact of hybrid therapy comprising peritoneal dialysis (PD) and hemodialysis on cardiovascular events in PD patients remains unclear. Objective: We aimed to evaluate the effect of hybrid therapy on cardiovascular events. Methods: A total of 93 PD patients undergoing hybrid therapy for ≥3 years were divided into 2 groups according to left ventricular ejection fraction (LVEF): lower ejection fraction (LEF [n = 29], LVEF < 60%) and normal ejection fraction (NEF [n = 64], LVEF ≥60%). Hospitalization rates and echocardiographic parameters were evaluated. Results: The 1-year hospitalization rate for acute cardiovascular events decreased after the therapy initiation in both groups (LEF: 0.36–0.11, p = 0.02 and NEF: 0.43–0.06, p < 0.001). In generalized linear mixed models, LVEF (44 ± 15%) improved at 1, 2, and 3 years after initiation (53 ± 18, 55 ± 17, and 58 ± 7%; p < 0.05) in the LEF group, whereas, in the NEF group, LVEF (68 ± 5%) was maintained at 1, 2, and 3 years after initiation (67 ± 8, 67 ± 9, and 68 ± 9%; p > 0.05). Mitral inflow E velocity to tissue Doppler e′ ratio was maintained at the same level at 1–3 years after initiation in both groups. Left ventricular mass index (LVMI; 189 ± 41 g/m²) was decreased at 1 (178 ± 35 g/m²; p = 0.8), 2 (160 ± 45 g/m²; p = 0.008), and 3 (166 ± 47 g/m²; p = 0.05) years after initiation in the LEF group, whereas in the NEF group, LVMI (157 ± 45 g/m²) was maintained at 1, 2, and 3 years after initiation (153 ± 40, 155 ± 54, and 158 ± 52 g/m²; p > 0.05). Conclusion: Hybrid therapy decreased acute cardiovascular events and improved systolic cardiac function in PD patients in the LEF group.

Association between Dialysis Modality and Cardiovascular Diseases: A Comparison between Peritoneal Dialysis and Hemodialysis

“…Fluid overload is common in PD patients [37][38][39][40][41][42][43][44] and an independent predictor of all-cause mortality [39,42]. Ng et al [41] reported that fluid overload was common in asymptomatic incident PD patients and a strong predictor of patient survival and cardiovascular events.…”

Combination of once-weekly haemodialysis with peritoneal dialysis is associated with lower mortality compared with peritoneal dialysis alone: a longitudinal study

“…As a result, some nephrologists start PD + HD therapy early after initiation of PD, believing that HD with little ultrafiltration in addition to PD preserves residual renal function and provides better nutritional status [ 13 ]. Many nephrologists utilize PD + HD therapy a few years following initiation [ 6 , 8 ] of PD when they judge that fluid and solute removal was insufficient with PD alone, though other nephrologists keep patients on PD alone until complete transition to HD. The decisions to start PD + HD therapy depend on the preferences of patients and their treating physicians.…”

“…Only a few studies have reported about outcomes of PD + HD therapy. In previous studies, after initiation of combination therapy, authors observed reduction in human atrial natriuretic peptide levels [ 6 ], improvement in blood pressure control [ 7 ], reduction in left ventricular mass index [ 6–8 ], improvement in left ventricular ejection fraction [ 8 ], reduction in hospitalization for cardiac events [ 8 , 9 ] and improvement in quality of life [ 10 , 11 ]. These studies suggest that PD + HD therapy may improve cardiovascular (CV) outcomes by better fluid removal by adding once-weekly HD to PD therapy.…”

The relationship of volume overload and its control to hypertension in hemodialysis patients

“…Hybrid therapies comprised of peritoneal dialysis (PD) and HD may also be a novel approach to better control volume and BP. One study reported an improvement in cardiac systolic function among 93 patients who underwent hybrid therapy for 3 years …”

“…One study reported an improvement in cardiac systolic function among 93 patients who underwent hybrid therapy for 3 years. 42 Standard dialysis therapies can also be modified for better volume and BP control. Correct prescription of dry weight and achievement of this weight with each HD treatment may improve volume control and BP.…”