Combination Therapy with Peritoneal Dialysis and Hemodialysis from the Initiation of Renal Replacement Therapy Preserves Residual Renal Function and Serum Albumin.

Abstract

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, blood parameters, and peritoneal permeability for 30 months. Residual renal function was better preserved in patients who received PD and HD combination therapy from the start of the dialysis therapy than in patients who received HD alone, and serum albumin was better preserved in the combination-therapy patients than in the patients who received PD alone. No significant differences in peritoneal permeability were observed between the patients on PD and those on combination therapy. Blood parameters were not significantly different between the three groups.Because our proactive combination therapy option has beneficial effects compared with HD or PD therapy alone, combination therapy should be considered a new modality of renal replacement therapy.