Abstract
Purpose
Clinically relevant evidence for the timing of starting combination therapy with peritoneal dialysis and hemodialysis remains scarce. We retrospectively examined whether combination therapy during the induction phase of dialysis prolongs peritoneal dialysis duration.
Methods
This retrospective study includes 160 patients who underwent combination therapy from 20 dialysis facilities. Four groups were categorized: combination at peritoneal dialysis induction (n = 12, Proactive combination group), and combination following peritoneal dialysis durations of < 2 years (n = 65), 2–5 years (n = 70), or > 5 years (n = 13). Differences in technique survival of dialysis, mortality, and hospitalization due to cardiovascular events in the groups were observed.
Results
The Proactive combination group had the longer mean duration of combination therapy (3.18 years) comparing to that of combination therapy following peritoneal dialysis (1.45 years), but total peritoneal dialysis duration was shorter than in control groups (4.02 years). Of the 160 cases in the entire cohort, there were 8 deaths, 18 ischemic heart disease hospitalizations, and 18 stroke hospitalizations. The Proactive group had lower crude mortality rate (0/12 cases, 0.0%) and crude hospitalization rate for ischemic heart disease (1/11, 8.3%) than the other groups. However, this cohort study did not have enough statistical power to adjust for patients’ background, and we were unable to fully examine the differences in such clinical outcomes by the timing of initiation of combination therapy.
Conclusion
Use of combination therapy in the induction phase might prolong the duration of combination therapy, but is not necessarily effective for prolonging peritoneal dialysis technique survival.
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Availability of data and material
The data that support the findings of this study are available on reasonable request from the corresponding author (KN).
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Acknowledgements
We wish to thank Tsutomu Sakurada (St. Marianna University Hospital), Tomo Suzuki (Kameda Medical Center), Naohiro Toda (Kansai Electric Power Hospital), Atsunori Yoshino (Dokkyo Medical University Saitama Medical center), Kyoko Maesato (Tokyo-Nishi Tokushukai Hospital), Mari Ishida, Takayo Miyakogawa (Tokai University Hachioji Hospital), Masato Ikeda, Izumi Shirai, Kyohei Ogawa, Kentaro Oshiro (The Jikei University Kashiwa Hospital), Hiroaki Io (The Juntendo University Nerima Hospital), Toshihiro Asai (Osaka City General Hospital), Arai Taichi, Ken Sakai (Toho University Omori Medical Center), Hidetoshi Kikuchi (Beppu Medical Center), Harumichi Higashi (St Mary's Hospital), Shotaro Naito (Tokyo Medical And Dental University Hospital), Tomohiro Kaneko (Nippon Medical School Tama Nagayama Hospital), Koji Hashimoto (Shinshu University Hospital), Morikuni Nishihira, Haruka Eda (Yuuai Medical Center), Hideki Yokoi (Kyoto University Hospital), Yukio Maruyama (The Jikei University Hospital), and Maiko Furuya and Mahiro Kurashige (The Jikei University Katsushika Medical Center) for participating in the study and contributing to data collection.
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Conception, design, and supervision of the study: AU. Data analysis: KN. Data collection: AU. Writing of the first draft of the manuscript: KN. All the authors agree with the manuscript results, conclusions, and publication.
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All the authors have declared no competing interests.
Ethical approval
The ethics committee at Hitachi General Hospital approved this study protocol (approval no. #2020–111), and waived the need to obtain informed consent from each subject based on the use of an opt-out format (https://www.hitachi.co.jp/hospital/hitachi/infor/opto-out/__icsFiles/afieldfile/2022/02/28/2021-93.pdf). Trial registration: UMIN-CTR, UMIN000050421, Registered 24 Feb 2023–Retrospectively registered, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057417.
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Nagai, K., Ueda, A. Effect of proactive combination therapy with peritoneal dialysis and hemodialysis on technique survival and mortality. J Artif Organs (2024). https://doi.org/10.1007/s10047-024-01437-z
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DOI: https://doi.org/10.1007/s10047-024-01437-z