A Reason for Choosing Peritoneal Dialysis: Lessons After the Japan Earthquake and the Fukushima Nuclear Accident

Abstract

Recently Ghaffari1Ghaffari A. Urgent-start peritoneal dialysis: a quality improvement report.Am J Kidney Dis. 2012; 59: 400-408Abstract Full Text Full Text PDF PubMed Scopus (99) Google Scholar described a safe and effective urgent-start peritoneal dialysis (PD) program. As the author discussed, PD provides outcomes similar to hemodialysis (HD) and has several advantages. In Japan, in addition to traditional PD therapy, HD/PD combination therapy, which comprises 5 or 6 days of PD combined with one HD session per week, is used for patients to control body fluid and remove solutes more effectively.2Matsuo N. Yokoyama K. Maruyama Y. et al.Clinical impact of a combined therapy of peritoneal dialysis and hemodialysis.Clin Nephrol. 2010; 74: 209-216Crossref PubMed Google Scholar The other advantage of the combination therapy is the availability of the treatment in emergency situations, such as natural disasters. The Japan earthquake in 2011 and subsequent Fukushima nuclear accident adversely affected dialysis patients not only in the destroyed and radioactively contaminated areas, but also in the adjacent areas. Medical resources were temporarily limited because of an increased influx of patients from the disaster zone, shortages of dialyzers and dialysates, and scheduled blackouts. In addition, patients experienced difficulty reaching hospitals due to traffic paralysis. At Kashiwa Hospital of Jikei University School of Medicine, 10 combination-therapy patients were forced to stop HD sessions for 2 weeks. However, because they could continue to perform PD even without being able to travel to a medical facility, their interdialytic body weight gain, serum urea nitrogen level, and creatinine and potassium levels were not significantly different before and after the earthquake (Table 1). Our experience shows the reliability of PD in emergency situations and should further encourage using PD as the initial modality of renal replacement therapy.Table 1Body Weight Gain and Laboratory MeasurementsBefore EarthquakeAfter EarthquakePBody weight gain relative to dry weight (%)2.4 ± 1.62.0 ± 1.30.6Serum urea nitrogen (mg/dL)57.9 ± 11.158.2 ± 17.00.9Creatinine (mg/dL)14.9 ± 1.915.6 ± 2.40.5Potassium (mEq/L)4.4 ± 0.84.5 ± 0.60.8Note: Measurements of 10 combination-therapy patients were obtained at the beginning of hemodialysis sessions before and 2 weeks after the earthquake and are expressed as mean ± standard deviation. Conversion factors for units: serum creatinine in mg/dL to µmol/L, ×88.4; serum urea nitrogen in mg/dL to mmol/L, ×0.357. No conversion necessary for serum potassium in mEq/L and mmol/L. Open table in a new tab Note: Measurements of 10 combination-therapy patients were obtained at the beginning of hemodialysis sessions before and 2 weeks after the earthquake and are expressed as mean ± standard deviation. Conversion factors for units: serum creatinine in mg/dL to µmol/L, ×88.4; serum urea nitrogen in mg/dL to mmol/L, ×0.357. No conversion necessary for serum potassium in mEq/L and mmol/L. Financial Disclosure: The authors declare that they have no relevant financial interests. Urgent-Start Peritoneal Dialysis: A Quality Improvement ReportAmerican Journal of Kidney DiseasesVol. 59Issue 3PreviewCompared with hemodialysis, peritoneal dialysis (PD) is a cost-effective and patient-centered option with an early survival advantage, yet only 7% of patients with end-stage renal disease in the United States receive PD. PD underutilization is due in part to nephrologists' unfamiliarity with directly starting PD in patients who present with kidney failure requiring urgent initiation of dialysis. Full-Text PDF In Reply to ‘A Reason for Choosing Peritoneal Dialysis: Lessons After the Japan Earthquake and the Fukushima Nuclear Accident’American Journal of Kidney DiseasesVol. 60Issue 2PreviewNatural disasters, especially those that affect transportation, electricity, and water supplies, highlight the dangers posed to patients with end-stage renal disease (ESRD) who are treated by hemodialysis (HD). Within the United States, Hurricane Katrina affected close to 6,000 dialysis patients. Despite evacuation plans, 44% of HD patients displaced by Katrina reported missing at least one HD session, whereas 16.8% reported missing 3 or more sessions.1 Full-Text PDF