Ultrafiltration volume by once‐weekly hemodialysis is a predictor of technique survival of combination therapy with peritoneal dialysis and hemodialysis

Abstract

Overhydration is a major cause of technique failure of peritoneal dialysis (PD). Hence, we investigated the impact of ultrafiltration (UF) volume by once‐weekly hemodialysis (HD), excess volume beyond their dry weight, on technique survival of PD and HD combination therapy (PD+HD). Forty‐six anuric PD+HD patients were divided into three groups according to baseline UF volume by HD: low‐UF (<mean − 1SD), middle‐UF (≥mean − 1SD and <mean + 1SD), and high‐UF (≥mean + 1SD). High‐UF group showed larger extracellular water normalized to height (P = .038) and longer HD sessions (P < .001) compared with low‐UF group, whereas low‐UF group was older than middle‐UF group (P = .001). Technique survival rate was significantly lower in high‐UF group than in low and middle‐UF groups (P < .001), and the rates at 44 months were 80%, 90%, 20% in low, middle, and high‐UF groups, respectively. Chronic overhydration was the leading cause of technique failure for all. This study suggests that fluid overload remains a major cause of technique failure of PD even after once‐weekly HD is added.

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

“…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.…”

Effluent N‐terminal expressed in renal cell carcinoma/mesothelin predicts increased peritoneal permeability in patients undergoing peritoneal dialysis

“…Although many studies have shown that survival after PD is comparable to HD [4][5][6], a poor technique survival rate is a major limitation of PD. Previous studies have reported that the main causes for discontinuing PD are overhydration, peritonitis, and underdialysis [7][8][9].…”