Is combined peritoneal dialysis and hemodialysis redundant? A nationwide study from Taiwan.
Admission
Cohort study
Combined therapy
Hemodialysis
Mortality
Peritoneal dialysis
Journal
BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793
Informations de publication
Date de publication:
15 08 2020
15 08 2020
Historique:
received:
14
01
2020
accepted:
29
07
2020
entrez:
18
8
2020
pubmed:
18
8
2020
medline:
21
10
2021
Statut:
epublish
Résumé
Combined peritoneal dialysis (PD) and hemodialysis (HD) therapy (combined therapy) has numerous clinical benefits and should be emphasized for PD patients encountering technique failure. This 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). All 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. Combined 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.
Sections du résumé
BACKGROUND
Combined peritoneal dialysis (PD) and hemodialysis (HD) therapy (combined therapy) has numerous clinical benefits and should be emphasized for PD patients encountering technique failure.
METHODS
This 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).
RESULTS
All 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.
CONCLUSIONS
Combined 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.
Identifiants
pubmed: 32799810
doi: 10.1186/s12882-020-01989-1
pii: 10.1186/s12882-020-01989-1
pmc: PMC7429794
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
348Commentaires et corrections
Type : CommentIn
Références
Sci Rep. 2016 Jul 27;6:30266
pubmed: 27461186
Contrib Nephrol. 2018;196:64-70
pubmed: 30041206
Nephron Clin Pract. 2010;116(4):c300-6
pubmed: 20639677
J Vasc Access. 2017 Mar 6;18(Suppl. 1):41-46
pubmed: 28297057
Contrib Nephrol. 2018;196:135-140
pubmed: 30041218
Clin Nephrol. 2006 Jan;65(1):43-7
pubmed: 16429841
Ther Apher Dial. 2004 Feb;8(1):56-61
pubmed: 15128021
Blood Purif. 2014;38(2):149-53
pubmed: 25471451
Rambam Maimonides Med J. 2015 Apr 29;6(2):e0017
pubmed: 25973269
Perit Dial Int. 2011 Sep-Oct;31(5):598-600
pubmed: 21976476
Kidney Int. 2015 Jun;87(6):1259-60
pubmed: 26024031
Adv Chronic Kidney Dis. 2011 Nov;18(6):428-32
pubmed: 22098661
Kidney Int. 2014 Nov;86(5):1016-22
pubmed: 24988066
Perit Dial Int. 2007 Jun;27 Suppl 2:S126-9
pubmed: 17556290
Clin J Am Soc Nephrol. 2011 Feb;6(2):447-56
pubmed: 21115629
Nephrol Dial Transplant. 2001;16 Suppl 5:61-6
pubmed: 11509687
Am J Kidney Dis. 2012 Jan;59(1):84-91
pubmed: 21849228
Kidney Int Suppl. 2002 Oct;(81):S53-61
pubmed: 12230482