Is combined peritoneal dialysis and hemodialysis redundant? A nationwide study from Taiwan

Abstract

Background: Combined peritoneal dialysis (PD) and hemodialysis (HD) therapy (combined therapy) has numerous clinical benefits and should be emphasized for PD patients encountering technique failure. Methods: This 12-year nationwide retrospective study was conducted to compare long-term outcomes (including admission and mortality risks) between combined therapy patients (combined group) and patients directly transferred from PD to HD (transfer group). Results: All 12,407 incidental PD patients from 2000 to 2010 were enrolled and followed up until the end of 2011. A total of 688 patients in the combined group and 688 patients in the transfer group were selected after 1:1 frequency matching based on age, sex, and PD duration. The overall admission and mortality risks of the two groups were comparable in a Cox proportional hazards model (adjusted hazard ratio [HR] = 1.06 [95% confidence interval (CI) = 0.95-1.19] and 1.02 [95% CI = 0.80-1.30]), respectively). Compared with the transfer group, combined group patients with recent peritonitis or frequent hemodialysis (four HD sessions per month) had significantly higher risk of admission while combined group patients without peritonitis had significantly lower risk. The number of incidents in the combined group increased over time. On average, patients stayed on combined therapy for 2 years. Conclusions: Combined therapy (two HD sessions per month) is not redundant but a rational and cost-effective treatment, particularly for patients without recent peritonitis. Dialysis staff should be familiar with the advantages and disadvantages of combined therapy and consider it an essential part of integrated dialysis care.

Clinical feasibility of transfer to combined therapy with peritoneal dialysis and hemodialysis for patients on peritoneal dialysis: A prospective multicenter study in Japan

“…Because the timing of changing modality and selection of the type of new modality, especially in terms of combined therapy or HD alone, were left to the discretion of the treating physicians. Recently, Chung et al [18] reported that mortality of patients on combined therapy was comparable to those patients directly transferred to HD using the Taiwanese national health insurance database. On the other hand, a strength of this study was the multicenter design as a prospective observational cohort study of incident PD patients, allowing us to reveal clinical outcomes among patients transferred to combined therapy and those transferred directly to HD.…”

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

“…A recent study by Chung et al suggested that mortality and hospitalization risks were similar between PD patients who were transferred to PD+HD and those who were transferred to HD in Taiwan [5]. However, the effects of PD+HD on long-term prognosis was unclear, since the treatment duration of PD+HD was too-short in the study.…”

“…Chung et al recently reported a retrospective cohort study comparing the risk of mortality and hospitalization (including emergent hospital visits) between PD+HD group (transfer from PD to PD+HD) and HD group (transfer from PD to HD) using a health insurance database in Taiwan [5]. An intention-to-treat analysis revealed that both risks were similar between the two groups, although peritonitis was a strong risk factor for hospitalization in PD+HD.…”

“…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.…”

Intra-Atrial Tunneled Dialysis Catheter as Vascular Access: Ultimate Choice in a Hemodialysis Patient

“…Combination of once-weekly hemodialysis with peritoneal dialysis, as in our case, reduce manipulation of the IATDC which can lower related risks and enhance median survival, but not indicated often although it has proven efficiency. [23,24] In fact, bimodal dialysis is associated with lower vascular access infection, and lower all-cause mortality compared with PD [25][26][27] This therapy is widely used in Japan (20% of all PD patients) [27]. Our experience with bimodal dialysis lasted for nine months before switching patient to exclusive hemodialysis.…”