Mixed-Mode Therapy: Kinetic Analysis and Acute Clinical Evaluation

Lysaght, Michael J.; Moran, John; Schindhelm, Klaus; Hayes, James M.; Farrell, Peter C.

doi:10.1159/000169609

Cited by 4 publications

(2 citation statements)

References 2 publications

(4 reference statements)

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“…To date, there have been three publications about combined modality of dialysis. Lysaght et al (5) evaluated 4 patients on mixed-mode therapy where all patients were on 1/week HD treatment and two 4-hour PD exchanges per day (16 hours dry daytime) for a period of 2 weeks. They adjusted the Kt/V per treatment for the HD session based on the difference between actual clearance delivered with PD and what would be needed to total a 3/week HD Kt/V target.…”

Section: Discussionmentioning

confidence: 99%

Combined Peritoneal Dialysis and Hemodialysis: Our Experience Compared to Others

2003

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Objective To determine the clinical experience of using combined-modality [simultaneous hemodialysis (HD) and peritoneal dialysis (PD)] treatment in patients with end-stage renal disease. Design We reviewed data on 4 patients from our center that were treated with “combined-mode therapy.” We then conducted a retrospective survey by sending questionnaires to nephrologists in the US and Canada by mail and by posting the survey on the Internet. Data queried included number of patients on combined modality, solute clearances, albumin levels pre and post combined therapy, reasons for using combined therapy, duration and success of combined therapy, and reimbursement issues. Setting and Participants Ours is a tertiary-care center. Patients that were not doing well on PD alone were put on combined modality of treatment between 1992 and 1998. Main Outcome Measures Clinical improvement in the indication for which the participant was started on combined modality. Results In response to the survey, data on 27 patients were collected. These data were combined with data on 4 patients from our unit that had previously been treated with combined HD and PD. Most patients were reported to have more than one clinical reason for changing from PD to combined therapy. The main clinical reason for offering combined treatments was inadequate solute clearance (34%), followed by ultrafiltration problems (16%) and neuropathy (11%). Mean duration of time followed on combined treatment was 8.5 ± 0.12 months. Most patients tolerated combined treatment well and were reported to show improvement in the clinical reasons for which they needed the combined modality. Dual access and reimbursement issues were not a problem. There was no single method used for calculating total (HD, PD, and residual renal) solute clearance. No universal total solute clearance goal was reported. Conclusion Hemodialysis and PD are not mutually exclusive. They can be used in combination to achieve targeted solute clearances, to improve certain clinical conditions, and to control volume and blood pressure in a subset of patients. Further evaluation is needed to better establish the long-term outcomes of using combined modality. Total solute clearance goals and methods for determining total solute clearance need to be standardized.

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Section: Discussionmentioning

confidence: 99%

Combined Peritoneal Dialysis and Hemodialysis: Our Experience Compared to Others

2003

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“…For example, several reports in the 1970s to 1980s described mixed HD and peritoneal dialysis regimens. 16,17 Further, mixed day and night schedules or mixed short and long daytime schedules have occasionally been used by patients-particularly those trained for home-to accommodate shift work and other lifestyle commitments. Such regimes have been described as hybrid.…”

Section: Hybrid Dialysismentioning

confidence: 99%

Chronic maintenance hemodialysis: Making sense of the terminology

Agar

MacGregor

Blagg

2007

Hemodialysis International

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During the early decades, the hemodialysis (HD) terminology for modality, technique and function altered little as the widely accepted regime of thrice-weekly, 4-hourly dialysis varied little. In the last decade, however, a wide range of new options have emerged in all facets of HD therapy. This has led to a sudden expansion in terminology, some duplicating, some contradictory, some superfluous. The definitions used in 1 geographical region may mean something entirely different elsewhere, increasing cross-continental misunderstanding and misinterpretation and raising the often-asked question: "What exactly did the authors mean by that?" Although clearly the definitions used in this paper are also only the authors' opinion, we have sought to explore the use and sometimes confusing application of many commonly used terms, and we propose a number of possible deletions. Finally, we offer a descriptive data set that we believe should be used for all HD-related papers. Our conclusions will not always be welcomed--particularly by those who use terms we have rejected. Despite this, we believe it pertinent to fully review the dialysis terminology we use. Primarily, we hope to stimulate debate about which terms should be globally adopted and what those terms should mean when used. Although not all will agree with our conclusions, we hope this paper may provide a framework for a more streamlined, efficient, and globally acceptable nomenclature.

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Bimodal Dialysis: Theoretical and Computational Investigations of Adequacy Indices for Combined Use of Peritoneal Dialysis and Hemodialysis

Dębowska

Waniewski²,

Lindholm³

2007

ASAIO Journal

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A theoretically correct method for evaluating the adequacy of bimodal dialysis (BMD), a combination of peritoneal dialysis (PD) and hemodialysis (HD) in the same patient, is lacking. We therefore performed computer simulations using a variable-volume, two-compartment urea kinetic model for 1-week treatments with 1) HD with three sessions, HD3, 2) continuous ambulatory PD, CAPD, 3) 6 days of CAPD and 1 day with HD session, and 4) 5 days of CAPD and 2 days with HD. Four dialysis adequacy indices (KT/V, stdKT/V, fractional solute removal, FSR, and equivalent clearance, EKR) were analyzed using four different reference methods for normalization of urea amount and concentration: 1) peak value, 2) peak average value, 3) time average value, and 4) treatment time average value. The analyses show that a proposed simplified rule of adding one third of weekly FSR for HD3 for each dialysis session and one seventh of weekly FSR for CAPD for each PD day for prediction of weekly FSR for BMD provides a fair prediction, although some corrections may be necessary, depending on the chosen reference method. In particular, KT/V may be added using this rule. We conclude that theoretically correct adequacy indices for BMD may be defined and calculated by using numerical simulations.

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Mixed-Mode Therapy: Kinetic Analysis and Acute Clinical Evaluation

Cited by 4 publications

References 2 publications

Combined Peritoneal Dialysis and Hemodialysis: Our Experience Compared to Others

Combined Peritoneal Dialysis and Hemodialysis: Our Experience Compared to Others

Chronic maintenance hemodialysis: Making sense of the terminology

Bimodal Dialysis: Theoretical and Computational Investigations of Adequacy Indices for Combined Use of Peritoneal Dialysis and Hemodialysis

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