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Evaluation of dialysis dose during combination therapy with peritoneal dialysis and hemodialysis.
Adv Perit Dial 2007; 23:135-9AP

Abstract

Peritoneal dialysis (PD) is effective way to preserve residual renal function (RRF) and should be the first-line dialysis option. However, after the loss of RRF, there are limitations to how well PD alone can control the uremic state. Combination therapy with PD and hemodialysis (PD+HD) is the simplest way to deal with these limitations. The general prescription for PD+HD should be 5-6 days of PD and 1 HD session weekly. To determine the adequacy of PD+HD, we adopted the equivalent renal clearance (EKR), first transforming the weekly PD adequacy index (Kt/V), and then evaluating total clearance from both modalities. However the EKR may overestimate the dialysis dose. To accurately track dialysis dose, we use the total effluent (PD, RRF and HD) sampling method to yield Kt/Vef and creatinine clearance (CCref). In comparing PD+HD with 7 days of PD alone, we found that weekly Kt/Vef increased to 2.27 +/- 0.43 from 1.55 +/- 0.4, and weekly CCref increased to 60.3 +/- 9.2 L/1.73 m2 from 42.0 +/- 7.7 L/1.73 m2 (p < 0.001). In addition, the normalized protein equivalent of nitrogen appearance, percentage creatinine generation rate, and percentage lean body mass also increased (respectively) to 0.93 +/- 0.16 g/kg from 0. 77 +/- 0.14 g/kg daily, to 126.5% +/- 21.2% from 82.6% +/- 17.1 %, and to 66.7% +/- 10.9% from 48.2% +/- 8.9% (p < 0.001). Protein losses in PD+HD were not different from those in PD alone, but serum albumin increased significantly to 3.6 +/- 0.3 g/dL from 3.3 +/- 0.3 g/dL, and serum beta2-microglobulin decreased to 23.5 +/- 11.1 mg/L from 33.3 +/- 11.3 mg/L. The total effluent sampling method can be used to evaluate the dialysis dose in PD+HD. The addition of once-weekly HD improved indices of nutrition, with increases in dialysis dose and serum albumin level. In patients without RRF, PD+HD is recommended as a dialysis regimen to maintain the optimal dialysis dose and good nutrition status without peritoneal deterioration from an increase in the PD fluid volume.

Authors+Show Affiliations

Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan. h-kawanishi@tsuchiya-hp.jpNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17886620

Citation

Kawanishi, Hideki, et al. "Evaluation of Dialysis Dose During Combination Therapy With Peritoneal Dialysis and Hemodialysis." Advances in Peritoneal Dialysis. Conference On Peritoneal Dialysis, vol. 23, 2007, pp. 135-9.
Kawanishi H, Moriishi M, Tsuchiya S. Evaluation of dialysis dose during combination therapy with peritoneal dialysis and hemodialysis. Adv Perit Dial. 2007;23:135-9.
Kawanishi, H., Moriishi, M., & Tsuchiya, S. (2007). Evaluation of dialysis dose during combination therapy with peritoneal dialysis and hemodialysis. Advances in Peritoneal Dialysis. Conference On Peritoneal Dialysis, 23, pp. 135-9.
Kawanishi H, Moriishi M, Tsuchiya S. Evaluation of Dialysis Dose During Combination Therapy With Peritoneal Dialysis and Hemodialysis. Adv Perit Dial. 2007;23:135-9. PubMed PMID: 17886620.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of dialysis dose during combination therapy with peritoneal dialysis and hemodialysis. AU - Kawanishi,Hideki, AU - Moriishi,Misaki, AU - Tsuchiya,Shinichiro, PY - 2007/9/25/pubmed PY - 2007/11/8/medline PY - 2007/9/25/entrez SP - 135 EP - 9 JF - Advances in peritoneal dialysis. Conference on Peritoneal Dialysis JO - Adv Perit Dial VL - 23 N2 - Peritoneal dialysis (PD) is effective way to preserve residual renal function (RRF) and should be the first-line dialysis option. However, after the loss of RRF, there are limitations to how well PD alone can control the uremic state. Combination therapy with PD and hemodialysis (PD+HD) is the simplest way to deal with these limitations. The general prescription for PD+HD should be 5-6 days of PD and 1 HD session weekly. To determine the adequacy of PD+HD, we adopted the equivalent renal clearance (EKR), first transforming the weekly PD adequacy index (Kt/V), and then evaluating total clearance from both modalities. However the EKR may overestimate the dialysis dose. To accurately track dialysis dose, we use the total effluent (PD, RRF and HD) sampling method to yield Kt/Vef and creatinine clearance (CCref). In comparing PD+HD with 7 days of PD alone, we found that weekly Kt/Vef increased to 2.27 +/- 0.43 from 1.55 +/- 0.4, and weekly CCref increased to 60.3 +/- 9.2 L/1.73 m2 from 42.0 +/- 7.7 L/1.73 m2 (p < 0.001). In addition, the normalized protein equivalent of nitrogen appearance, percentage creatinine generation rate, and percentage lean body mass also increased (respectively) to 0.93 +/- 0.16 g/kg from 0. 77 +/- 0.14 g/kg daily, to 126.5% +/- 21.2% from 82.6% +/- 17.1 %, and to 66.7% +/- 10.9% from 48.2% +/- 8.9% (p < 0.001). Protein losses in PD+HD were not different from those in PD alone, but serum albumin increased significantly to 3.6 +/- 0.3 g/dL from 3.3 +/- 0.3 g/dL, and serum beta2-microglobulin decreased to 23.5 +/- 11.1 mg/L from 33.3 +/- 11.3 mg/L. The total effluent sampling method can be used to evaluate the dialysis dose in PD+HD. The addition of once-weekly HD improved indices of nutrition, with increases in dialysis dose and serum albumin level. In patients without RRF, PD+HD is recommended as a dialysis regimen to maintain the optimal dialysis dose and good nutrition status without peritoneal deterioration from an increase in the PD fluid volume. SN - 1197-8554 UR - https://www.unboundmedicine.com/medline/citation/17886620/Evaluation_of_dialysis_dose_during_combination_therapy_with_peritoneal_dialysis_and_hemodialysis_ L2 - https://medlineplus.gov/kidneyfailure.html DB - PRIME DP - Unbound Medicine ER -