POS-704 COMPARABLE OUTCOMES BETWEEN THRICE-WEEKLY HEMODIALYSIS AND COMBINATION OF PERITONEAL DIALYSIS WITH ONCE-WEEKLY HEMODIALYSIS

Abstract

Combination of peritoneal dialysis (PD) and once-weekly hemodialysis (HD) (PD+HD) is almost exclusively performed in Japan. Outcomes of this treatment has not been extensively studied in a large cohort. This is a prospective cohort study on Japanese Society for Dialysis Therapy Renal Data Registry. Inclusion criteria were those who transited from PD to thrice-weekly HD or to PD+HD therapy from 2011 to 2018. Exposure of interest was PD+HD therapy compared with thrice-weekly HD. Outcome was time to all-cause and cause-specific death. Those who transited to thrice-weekly HD and PD+HD therapy were matched by propensity scores estimated from data of previous years, including demographics, residual kidney function, and history of peritonitis. Associations between PD+HD therapy and outcomes were examined by Cox regression. Among matched cohort, 1033 subjects were in HD and PD+HD groups, respectively. Mean age was 60.3 (11.8) years, 72.3% were male, and median PD vintage at the end of previous year was 2.3 (1.0-3.9) years. During a median follow-up of 3.5 years, 303 subjects died. There were no differences in all-cause, cardiovascular (CV), congestive heart failure (CHF)-related, or infection-related mortality among those on PD+HD therapy compared with those on thrice-weekly HD (HR: 0.97 [0.77-1.21], 1.11 [0.77-1.59], 0.90 [0.52-1.54], and 0.90 [0.55-1.50], respectively). Competing risk regression in which mortality from the other causes was treated as a competing risk showed that SHR for CV, CHF-related, and infection-related mortality were 1.09 (0.76-1.57), 0.86 (0.50-1.48), and 0.79 (0.56-1.55), respectively. All-cause and cause-specific mortality were not significantly different between those who transited from PD to thrice-weekly HD and those transited to PD+HD therapy. Considering quality of life and flexible lifestyle, PD+HD therapy could be a great option for patients with end-stage kidney disease.