title: Clinical impact of a combined therapy of peritoneal dialysis and hemodialysis.
abstract: OBJECTIVE
  Although peritoneal dialysis (PD) is recommended as the first-line treatment for end-stage renal disease, limitations exist to achieving good clinical status when the residual renal function (RRF) has declined. Combined therapy with PD and hemodialysis (HD) is the treatment of choice for patients who cannot control body fluid status and/or cannot obtain adequate solute removal by PD alone. The aim of this study was to evaluate the clinical efficacy of this combined therapy.
  
  
  METHODS
  In this retrospective study, 53 patients on PD and diagnosed with underdialysis and/or overhydration with declining RRF were recruited. Parameters of volume control, uremic solute removal, anemia, and predictors for encapsulating peritoneal sclerosis (EPS) were compared before and 1 year after combined therapy.
  
  
  RESULTS
  The patients' hydration status improved significantly with reductions in atrial natriuretic peptide and blood pressure. Serum creatinine and beta2 microglobulin also decreased significantly. The hemoglobin level increased remarkably from 8.2 ± 1.6 to 10.7 ± 1.2 g/dl (p < 0.01) and the reticulocyte count also increased significantly, even though at the same time the dose of recombinant human erythropoietin decreased significantly. The dialysate to plasma creatinine ratio obtained from the fast peritoneal equilibration test (PET) decreased significantly from 0.65 ± 0.11 to 0.59 ± 0.13, and the level of interleukin 6 in PET drainage also significantly decreased. Furthermore, serum C-reactive protein and fibrinogen decreased significantly.
  
  
  CONCLUSIONS
  Combined therapy with PD and HD is an effective way to control fluid status and to correct inadequate solute removal, leading to improvement in inflammation, peritoneal function and anemia.
authors.affiliation: Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan. nana77m@jikei.ac.jp
authors.forename: N
authors.initials: N
authors.lastname: Matsuo
authors.forename: K
authors.initials: K
authors.lastname: Yokoyama
authors.forename: Y
authors.initials: Y
authors.lastname: Maruyama
authors.forename: Y
authors.initials: Y
authors.lastname: Ueda
authors.forename: H
authors.initials: H
authors.lastname: Yoshida
authors.forename: Y
authors.initials: Y
authors.lastname: Tanno
authors.forename: R
authors.initials: R
authors.lastname: Yamamoto
authors.forename: H
authors.initials: H
authors.lastname: Terawaki
authors.forename: M
authors.initials: M
authors.lastname: Ikeda
authors.forename: K
authors.initials: K
authors.lastname: Hanaoka
authors.forename: H
authors.initials: H
authors.lastname: Yamamoto
authors.forename: M
authors.initials: M
authors.lastname: Ogura
authors.forename: S
authors.initials: S
authors.lastname: Watanabe
authors.forename: Y
authors.initials: Y
authors.lastname: Kimura
authors.forename: T
authors.initials: T
authors.lastname: Hosoya
mesh_terms: D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D001613:beta 2-Microglobulin / Q000097:blood
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D015850:Interleukin-6; D001613:beta 2-Microglobulin; D005340:Fibrinogen; D002097:C-Reactive Protein; D003404:Creatinine