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Combining hemodialysis and peritoneal dialysis therapy offers improved outcomes
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ORLANDO, Fla. — Patients treated with combined hemodialysis and peritoneal dialysis from the start of renal replacement therapy showed advantages over patients who used a single therapy only, according to researchers from Japan who presented at the Annual Dialysis Conference here. The combined therapy helped the study group stay on dialysis for more than 10 years.
In the study, Atsushi Ueda, MD, and colleagues found the main benefits of this combination therapy were the preservation of residual renal function (RRF) and serum albumin levels. The researchers detailed a case of a 51-year-old woman with diabetic nephropathy placed on peritoneal dialysis (PD) and hemodialysis (HD) therapy as a first dialysis method in 2008. The dialysis schedule consisted of 5 days per week on PD, 1 day on HD and 1 day off a week. Kt/Vs of residual renal function, calculated for both PD and HD and calculated by equivalent renal urea clearance, was measured and peritoneal equilibration tests were performed every 6 months. At the beginning of this therapy, Kt/V for hemodialysis, peritoneal dialysis and residual renal function (RRF) was 0.81, 1.29 and 0.52, respectively.
“Interestingly, Kt/V of RRF increased to 1.29 at 6 months. It kept absolutely stable within 96 months and [was] 0.44 at 120 months,” Ueda said. “The mean Kt/V of RRF, PD and HD was 0.85, 1.32 and 0.83, respectively. The mean for 10 years urine volume was 943 mL/day and the peritoneal fluid removal volume was 733 mL/day … peritoneal permeability did not increase for 10 years,” the group wrote in the ADC abstract. “Albumin level maintained stable; in addition, anemia, inflammation and nutrition status kept as good control.”
The advantage of proactive combination therapy started at the initiation of dialysis, the researchers said, included fluid control kept well by urine and ultrafiltration of PD therapy.
“… These effects could bring not only the long-term continuation of dialysis but also the improvement in anemia, inflammation and nutrition status,” the researchers wrote. “This case demonstrated that this new combination therapy was extremely useful for preserving both RRF and peritoneal function, indicating a good prognosis.” – by Mark E. Neumann
Reference:
A Ueda, et al. A case in which renal function and peritoneal function were maintained for 10 years by the proactive combination therapy with peritoneal dialysis and hemodialysis. Poster presented at: Annual Dialysis Conference; March 3-6, 2018; Orlando, Fla.
Disclosures: The authors reported no relevant financial disclosures.