Effect of Combined Peritoneal Dialysis and Hemodialysis on Health-Related Quality of Life.

BACKGROUND: In Japan, combined peritoneal dialysis (PD) and hemodialysis (HD) therapy is performed widely as an established modality of renal replacement therapy. This combination therapy is indicated for patients who cannot maintain adequate solute clearance using a standard PD prescription, or those who have uremic symptoms or a state of persistent fluid overload. A common treatment schedule for combined PD + HD therapy consists of 5 days of PD and one HD session per week. A 4- to 5-h HD session is performed with a high-flux membrane dialyzer. On the HD day and the following day, patients are released from bag exchange for PD, defined as a PD holiday. The effectiveness of combined PD + HD therapy for solute clearance and fluid management has been recognized, but only a few reports have considered whether combined PD + HD therapy improves health-related quality of life (HRQOL) in uremic PD patients. We prospectively assessed clinical parameters and HRQOL by using the Short Form Health Survey-Version 2 (SF-36) and the Kidney Disease Quality of Life Instrument-Short Form (KDQOL-SF) before and 1 year after initiation of combined PD + HD therapy in 10 Japanese PD patients who could not achieve adequate solute clearance or fluid volume control. After starting combined PD + HD therapy, body weight and urine volume decreased and renal anemia and azotemia improved. Evaluation of HRQOL with the SF-36 showed improvement in physical function (72.9 ± 12.4 vs. 79.1 ± 12.4, p < 0.05). KDQOL scores for the symptoms/problems (68.3 ± 12.2 vs. 80.2 ± 17.6, p < 0.05) and effect of kidney disease (77.2 ± 12.1 vs. 82.8 ± 14.5, p < 0.05) showed significant improvement.

SUMMARY: Combined PD + HD therapy improved fluid volume management and uremic symptoms, leading to better HRQOL. Key Messages: Combined therapy improved fluid management and uremic symptoms, leading to better HRQOL.