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

Mu-Chi Chung,Ming-Ju Wu,Cheng-Hsu Chen,Chi-Jung Chung,Peir-Haur Hung,Jeng-Jer Shieh,Chao-Hsiang Chang,Tung-Min Yu,Jein-Wen Chen,Chih-Hsin Muo,Ya-Wen Chuang

doi:10.1186/s12882-020-01989-1

Abstract

BackgroundCombined peritoneal dialysis (PD) and hemodialysis (HD) therapy (combined therapy) has numerous clinical benefits and should be emphasized for PD patients encountering technique failure.MethodsThis 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).ResultsAll 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.ConclusionsCombined 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.

Highlights

Combined peritoneal dialysis (PD) and hemodialysis (HD) therapy has numerous clinical benefits and should be emphasized for PD patients encountering technique failure
Technique failure requires 10% of patients with PD per year to switch to HD [4] and the timely transfer of PD patients to HD is important for long-term survival [5]
The present study aimed to explore the current practice of combined therapy and to clarify the long-term prognosis for mortality and admission risks if PD patients select it as bridge therapy

Summary

Introduction

Combined peritoneal dialysis (PD) and hemodialysis (HD) therapy (combined therapy) has numerous clinical benefits and should be emphasized for PD patients encountering technique failure. Several studies showed that combined therapy could increase dialysis adequacy, decrease fluid overload, improve peritoneal membrane function, and boost quality of life [6,7,8,9]. These single-center studies were limited by small patient numbers and focused on before versus after comparisons. One single-center study indicated an equivalent mortality risk for combined therapy, HD alone, and PD alone [10]

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