Hybrid dialysis is a viable option to extend peritoneal dialysis technique survival

Dr Mandy Law1, Ms Jill Bone1, Mr Matthew Harvey1, Ms Angela Daffey1, Ms Anne-Marie Desai1, Ms Jo Englezos1, Professor Lawrence P McMahon1,2, Dr Louis Huang1,2

1Department of Renal Medicine, Eastern Health, Box Hill, Australia, 2Monash University, Clayton, Australia

Introduction

Hybrid dialysis by adding weekly haemodialysis (HD) to peritoneal dialysis (PD) may be a suitable strategy to improve solute and fluid clearance whilst keeping patients home to maintain quality of life. There is limited reporting of the use of hybrid dialysis in Australia.

Method

This is a retrospective review of a single-centre approach to identifying PD patients with inadequate therapy (total CrCl <70 L/week, or Kt/V <1.7 and symptomatic) and the multidisciplinary support to extend PD technique survival. Baseline assessments of symptoms using POS-S Renal, DASS21 and PHQ9, NSQOL and MIS instruments were performed by PD nurses, social worker, psychologist and dieticians.

Results

Thirteen patients were assessed as suitable for hybrid dialysis and have extended PD technique survival in 11 patients by 6 [range 1-24]months. Median total CrCl and Kt/V prior to commencement of hybrid dialysis were 60.4 [56.5-62.8]L/week and 1.9 [1.7-2.1], respectively. The most common symptoms reported on the POS-S Renal were ”weakness”,  “drowsiness”, “itch” and “difficulty sleeping”. Depressive symptoms were common (72-86%). Nine patients started hybrid therapy using an arteriovenous fistula (AVF), whilst 2 started via permacaths.  Two patients had AVF created but received kidney transplantation prior to starting hybrid dialysis. Five patients ceased hybrid therapy for reasons including peritonitis, inadequate solute removal and withdrawal. Two patients received kidney transplantation. Four patients remain on hybrid dialysis with one having extended technique survival by 24 months.

Conclusion

Hybrid dialysis is suitable in select patients to improve dialysis adequacy and maintain quality of life, whilst extending PD technique survival.


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