The Authors Reply

Abstract

We thank Matsuo et al.1Matsuo N. Yokoyama K. Tanno Y. et al.Combined therapy using peritoneal dialysis and hemodialysis may increase the indications for peritoneal dialysis in the United States.Kidney Int. 2015; https://doi.org/10.1038/ki.2015.56Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar for their comment regarding combined peritoneal and hemodialysis (CPD). The simultaneous use of peritoneal (PD) and hemodialysis (HD) offers a viable solution in emergency situations and may afford potential benefits to a subgroup of PD patients2Agarwal M. Clinard P. Burkart J.M. Combined peritoneal dialysis and hemodialysis: our experience compared to others.Perit Dial Int. 2003; 23: 157-161PubMed Google Scholar. The current US shortage of PD solutions has been a challenge for PD programs, many of which have struggled to place new patients on PD in the latter half of 2014. CPD could have alleviated the situation by permitting flexibility in the dialysis prescription for new and existing patients. CPD could be considered a self-care dialysis option augmented by in-center HD. It could potentially increase technique survival for some PD patients by permitting those struggling to maintain adequate solute and water clearance to continue PD. A single weekly HD session could optimize dialysis for marginal PD patients, including larger patients, low transporters, and those without significant residual renal function. The downside of CPD would be the requirement for dual PD and vascular access, potentially increasing risk of infection. Alternatively, the presence of an arteriovenous graft or fistula would ease the transition to HD when the time came for a permanent switch. In the United States and countries with diverse demographics, larger observational studies are needed to determine whether CPD would be an acceptable alternative to PD or HD alone, and to determine whether CPD is associated with a survival benefit.