Complementary dialysis for daily dialysis.
The greatest benefit of PD ist the continuous maintenance of a stable electrolyte and acid-base balance, as well as a continuous solute, sodium and water removal. Moreover, PD is effective in preserving residual renal function (RRF). However, when RRF declines, complications will occur if not compensated for by an increase in both the dialysis dose and ultrafiltration. Combination therapy PD and HD has been implemented to address the weakness of PD. The weak points of PD are declining UF volume and solute removal over time. The most important weak point of HD is the intermittent nature of the treatment. Based on this, the following concept was developed. At the start of dialysis, PD should be initiated in order to maintain RRF. In this stage, the function of PD is a complement to the RRF. When RRF declines, combination PD and HD should be considered. Subsequently, to achieve sufficient solute removal and ultrafiltration, the number of HD sessions should increase and PD prescription may decrease, resulting in three HD sessions per week and low-volume PD on non-HD days. Thus, PD complements HD in the end. If this integration can become a reality, we can accomplish 'real' daily dialysis.
Kawanishi
Hideki
H
Tsuchiya General Hospital, Hiroshima, Japan. hidekawa@enjoy.ne.jp
D001071:Appointments and Schedules; D003131:Combined Modality Therapy; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D010530:Peritoneal Dialysis / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome