Document Detail


Clinical impact of a combined therapy of peritoneal dialysis and hemodialysis.
MedLine Citation:
PMID:  20860905     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: 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:
N Matsuo; K Yokoyama; Y Maruyama; Y Ueda; H Yoshida; Y Tanno; R Yamamoto; H Terawaki; M Ikeda; K Hanaoka; H Yamamoto; M Ogura; S Watanabe; Y Kimura; T Hosoya
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical nephrology     Volume:  74     ISSN:  0301-0430     ISO Abbreviation:  Clin. Nephrol.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-23     Completed Date:  2010-11-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0364441     Medline TA:  Clin Nephrol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  209-16     Citation Subset:  IM    
Affiliation:
Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan. nana77m@jikei.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Biological Markers
C-Reactive Protein / metabolism
Chi-Square Distribution
Creatinine / blood
Female
Fibrinogen / analysis
Hemoglobins / analysis
Humans
Interleukin-6 / blood
Kidney Failure, Chronic / physiopathology,  therapy*
Male
Middle Aged
Peritoneal Dialysis / methods*
Renal Dialysis / methods*
Retrospective Studies
Statistics, Nonparametric
Treatment Outcome
beta 2-Microglobulin / blood
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Hemoglobins; 0/Interleukin-6; 0/beta 2-Microglobulin; 60-27-5/Creatinine; 9001-32-5/Fibrinogen; 9007-41-4/C-Reactive Protein

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