Combination Therapy with Hemodialysis and Peritoneal Dialysis

Abstract

Both continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) have their advantages regarding the treatment of patients with renal failure. In CAPD, solute removal is sometimes insufficient in patients who have a relatively large muscle mass that produces high levels of creatinine. To compensate for this deficiency, frequent exchanges and large peritoneal dialysate volumes are required. Alternatively, CAPD and HD as a combined modality of treatment for patients needing dialysis therapy has been proposed. Our experiences with three groups of patients are described. First, in 2003, 7 cases (6 males and 1 female; average age 54.3 ± 4.5 years; mean duration of CAPD therapy 4.3 ± 1.1 years; average weekly creatinine clearance (WCC) was 45.2 ± 1.7 l/1.73 m(2)) were treated with once-a-week HD therapy (3.5 h; 200 ml/h). Addition of once-a-week HD therapy improved WCC to 66 ± 7.1 liters/1.73 m(2). This improvement was due not only to the addition of HD therapy but also to an increase in creatinine clearance for 3 consecutive days after the completion of once-a-week HD therapy. Both creatinine clearance and ultrafiltration were significantly increased. Other clinical parameters such as blood pressure control, weight control, and dosage of erythropoietin were significantly improved after introducing this therapy. Second, we followed 9 CAPD patients who underwent an additional weekly HD for more than 3 years. Similar improvements were obtained in this long-term study as seen in the short-term study. Besides, the incidence of peritonitis decreased dramatically from 0.13 to 0.09 episodes/patient-year (p < 0.05) during the 3-year study. These data suggest that the combined use of CAPD and HD improves solute clearance in CAPD patients who are insufficiently dialyzed. Third, based on these data, we examined the efficacy of an early start of combination therapy and found that it stabilized dialysis therapy and prolonged the duration of CAPD. Combined with several of the previous several reports and our present experience, it is suggested that an early start of HD therapy will prolong the survival rate in patients on CAPD with physically stable conditions.

Combined Therapy with Peritoneal Dialysis and Hemodialysis: A Multicenter Retrospective Observational Cohort Study in Japan

“…At the start of the combined therapy, the median PD duration was approximately 3 years, which is similar according to the previous reports [3,4,5,6]. In the current study, body weight decreased following the initiation of combined therapy, suggesting that overhydration was a main cause for starting this therapy, whereas there was only a small change in solute clearance, including Kt/V and weekly Ccr, and circulating β2 microglobulin was not increased at baseline.…”

“…In the current study, body weight decreased following the initiation of combined therapy, suggesting that overhydration was a main cause for starting this therapy, whereas there was only a small change in solute clearance, including Kt/V and weekly Ccr, and circulating β2 microglobulin was not increased at baseline. During 3 months of combined therapy, both hydration status (represented by body weight and hemoglobin) and dialysis adequacy (represented by serum creatinine levels) were significantly improved as indicated in many previous reports [3,5,6,9]. On the other hand, the change in serum β2 microglobulin levels did not reach significance.…”

“…Although there have been several published reports, most studies till date were limited by the population size or by being single-center studies [3,4,5,6,7,8,9]. To better evaluate the clinical benefit of this modality, we established the Evaluation of the Adequacy of Renal replacement THerapy (EARTH) Study Group.…”

Assessing the Adequacy of Small Solute Clearance for Various Dialysis Modalities, with Inclusion of Residual Native Kidney Function

“…Most reported combinations have occurred in the setting of failing adequacy in long‐term PD patients whose clearances of both urea and creatinine have fallen below target, with evidence of clinical decline. One to three HD treatments per week have been added to CAPD treatments in this setting as well as in the setting of early start PD . In the late PD setting, K RU is usually negligible so the caregiver is mainly interested in the total of CAPD and HD clearances.…”

Clinical efficacy of combined therapy with peritoneal dialysis and hemodialysis

“…Although several reports have shown the effectiveness and impact of combined therapy with PD and HD, most have been limited by sample size or by being single-center studies [6,[9][10][11][12][13][14][15][16][17][18][19][20] (Table 1). In these reports, the terminology have not been standardized (i.e., combined therapy, combination therapy, hybrid therapy, complementary dialysis, and bimodal dialysis).…”