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.

journal_name

BMC Nephrol

journal_title

BMC nephrology

authors

Chung MC,Yu TM,Wu MJ,Chuang YW,Muo CH,Chen CH,Chang CH,Shieh JJ,Hung PH,Chen JW,Chung CJ

doi

10.1186/s12882-020-01989-1

subject

Has Abstract

pub_date

2020-08-15 00:00:00

pages

348

issue

1

issn

1471-2369

pii

10.1186/s12882-020-01989-1

journal_volume

21

pub_type

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