Combination of once-weekly haemodialysis with peritoneal dialysis is associated with lower mortality compared with peritoneal dialysis alone: a longitudinal study.

Published on May 28, 2021in Ndt Plus0.61
· DOI :10.1093/CKJ/SFAA173
Miho Murashima2
Estimated H-index: 2
(Nagoya City University),
Takayuki Hamano39
Estimated H-index: 39
(Nagoya City University)
+ 1 AuthorsIkuto Masakane33
Estimated H-index: 33
Sources
Abstract
Background Approximately 20% of patients on peritoneal dialysis (PD) in Japan are on combination with once-weekly haemodialysis (HD). This study aimed to compare outcomes of combination therapy and PD alone. Methods This longitudinal study on the Japanese Renal Data Registry included patients on PD from 2010 to 2014. Subjects were followed until the end of 2015. Exposure of interest was combination therapy compared with PD alone. Outcomes were complete transition to HD, all-cause mortality, cardiovascular (CV) mortality and congestive heart failure (CHF)-related mortality. Patients who initiated combination therapy were matched with those on PD alone by propensity scores. Data were analysed using Cox regression models. Results Among the matched cohort, 608 patients were on combination therapy and 869 were on PD alone. Decline in body weight and residual renal function was more prominent in the combination therapy group. During a median follow-up of 2.5 years, 224 deaths occurred. All-cause mortality {hazard ratio (HR) [95% confidence interval (CI)] 0.56 (0.42-0.75)}, CV mortality [HR 0.48 (0.32-0.72)] and CHF-related mortality [HR 0.19 (0.07-0.55)] were significantly lower, but complete transition to HD was significantly earlier [HR 1.72 (1.45-2.03)] in the combination therapy group. Sensitivity analyses considering the effects of dialysis facilities yielded similar results. Assuming causality, numbers needed to treat to prevent one death per year were 34 patients. Conclusions Combination therapy was associated with lower all-cause mortality, CV mortality and CHF-related mortality, but earlier transition to HD compared with PD alone, which might be due to better fluid removal by HD.
References14
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#1Masanori Abe (Nihon University)H-Index: 22
#2Takayuki Hamano (Osaka University)H-Index: 39
Last. Hidetomo Nakamoto (Saitama Medical University)H-Index: 33
view all 9 authors...
There has been no nationwide study of prognostic factors and outcomes in patients on peritoneal dialysis (PD) in Japan. We conducted a cohort study using data from the nationwide registry of the Japanese Society for Dialysis Therapy. We followed 8,954 prevalent PD patients for 2 years, 2014–2015. Cox proportional hazards regression analysis was used to determine factors that were independently associated with patient survival. Survival rates were compared between patients with and without diabet...
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#2Hideki KawanishiH-Index: 29
Last. Shinichiro TsuchiyaH-Index: 9
view all 5 authors...
BACKGROUND: The impact of hybrid therapy comprising peritoneal dialysis (PD) and hemodialysis on cardiovascular events in PD patients remains unclear. OBJECTIVE: We aimed to evaluate the effect of hybrid therapy on cardiovascular events. METHODS: A total of 93 PD patients undergoing hybrid therapy for ≥3 years were divided into 2 groups according to left ventricular ejection fraction (LVEF): lower ejection fraction (LEF [n = 29], LVEF 0.05). Mitral inflow E velocity to tissue Doppler e' ratio wa...
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Background: In Japan, combined peritoneal dialysis (PD) and hemodialysis (HD) therapy is performed widely as an established modality of renal replacement therapy. This combination therapy is indicated for patients who cannot maintain adequate solute clearance using a standard PD prescription, or those who have uremic symptoms or a state of persistent fluid overload. A common treatment schedule for combined PD + HD therapy consists of 5 days of PD and one HD session per week. A 4- to 5-h HD sessi...
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Background and objectives Technique failure is a major limitation of peritoneal dialysis. Our study aimed to identify center- and patient-level predictors of peritoneal dialysis technique failure. Design, setting, participants, & measurements All patients on incident peritoneal dialysis in Australia from 2004 to 2014 were included in the study using data from the Australia and New Zealand Dialysis and Transplant Registry. Center- and patient-level characteristics associated with technique failur...
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#1Reo Kanda (Juntendo University)H-Index: 7
#2Hiroaki Io (Juntendo University)H-Index: 13
Last. Yusuke Suzuki (Juntendo University)H-Index: 44
view all 9 authors...
It is well known that a combination therapy with peritoneal dialysis (PD) and hemodialysis (HD) is feasible and may improve clinical status in patients for whom adequate solute and fluid removal is difficult to achieve with PD alone. The objective of the present study was to evaluate whether the therapy is useful in the likelihood of long-term peritoneal membrane and cardiac function. The therapy was 6 days of PD and one session of HD per week. Physical, biochemical, dialysate-to-plasma ratio of...
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#1Atsushi Ueda (Hitachi)H-Index: 3
#2Kei Nagai (University of Tsukuba)H-Index: 8
Last. Kunihiro Yamagata (University of Tsukuba)H-Index: 53
view all 5 authors...
: Peritoneal dialysis (PD) and hemodialysis (HD) combination therapy is considered for the improvement of ultrafiltration failure and uremic symptoms in PD patients with loss of residual renal function (RRF). However, a rapid decline in RRF is one of the critical drawbacks to such therapy. In contrast, we started patients on combination therapy as a proactive option at the initiation of dialysis.In patients on HD (n = 52), PD (n = 21), and combination dialysis (n = 13), we studied changes in RRF...
#1Ikuto MasakaneH-Index: 33
#2Takeshi HasegawaH-Index: 26
Last. Kosaku NittaH-Index: 61
view all 10 authors...
Since 2009, the peritoneal dialysis (PD) registry has been carried out as part of the annual nationwide survey conducted by the Statistical Survey Committee of the Japanese Society for Dialysis Therapy with the cooperation of the Japanese Society for Peritoneal Dialysis. In this study, the current status of PD patients is reported on the basis of the results of the survey conducted at the end of 2013. The subjects were PD patients who lived in Japan and participated in the 2013 survey. Descripti...
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#1Ikuto MasakaneH-Index: 33
#2Shigeru NakaiH-Index: 31
Last. Kosaku NittaH-Index: 61
view all 9 authors...
Abstract A nationwide survey of 4325 dialysis facilities was conducted at the end of 2013, among which 4268 (98.7%) responded. The number of new dialysis patients was 38,095 in 2013. Since 2008, the number of new dialysis patients has remained almost the same without any marked increase or decrease. The number of dialysis patients who died in 2013 was 30,751. The dialysis patient population has been growing every year in Japan; it was 314,438 at the end of 2013. The number of dialysis patients p...
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#1Yukio MaruyamaH-Index: 19
#2Keitaro YokoyamaH-Index: 30
Last. Tatsuo HosoyaH-Index: 56
view all 14 authors...
Background/Aims: Combining peritoneal dialysis (PD) and hemodialysis (HD) has been common treatment option in Japan. Methods: In this retrospective, multicenter, observational study, the clinical characteristics and outcomes of 104 patients (57 w 11 years, males 72%) who had switched from PD alone to combined therapy with PD and HD were studied. Clinical parameters were measured at baseline and after 3 months of combined therapy. Results: At baseline, urine volume, dialysate-to-plasma ratio of c...
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#1Hiromichi Suzuki (Saitama Medical University)H-Index: 32
#2Hitosi HoshiH-Index: 3
Last. Tsuneo TakenakaH-Index: 24
view all 6 authors...
: Although peritoneal dialysis (PD) has been recommended for initial dialysis therapy, a larger proportion of patients with end-stage renal disease choose hemodialysis (HD) instead. Several previous studies comparing the outcomes of these two therapies, including survival rates and cardiovascular events, have not clearly demonstrated the superiority of one over the other. Our recent study indicated that, compared with HD or PD alone, renal replacement therapy with HD and PD in combination prolon...
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