Transition to a combination of peritoneal dialysis and hemodialysis in chronic kidney disease patients receiving peritoneal dialysis treatment: A single-center study

Abstract

Peritoneal dialysis (PD) and hemodialysis (HD) are the two primary renal replacement therapies for patients with end-stage renal disease (ESRD). While PD is an effective and convenient modality, long-term use can lead to ultrafiltration failure, recurrent peritonitis, and progressive structural alterations in the peritoneal membrane, necessitating a transition to HD. In recent years, rather than a complete transition, the combined use of PD and HD has emerged as a viable alternative, offering potential advantages for selected patient populations.This retrospective study included patients with PD-related complications, such as resistant hypervolemia, frequent peritonitis episodes, peritoneal failure, and clinical deterioration. Based on eligibility criteria, patients were either transitioned to HD or initiated on combined PD+HD therapy. A total of 28 patients underwent transition to HD, while 26 received PD+HD combination therapy. Survival rates, Kt/V, residual urine output, and various laboratory parameters were evaluated and compared between the two groups. Both groups demonstrated significant improvements in Kt/V, volume stabilization, and cardiovascular stability after transitioning from PD. However, no statistically significant differences were observed in laboratory parameters between the two groups. These findings suggest that for patients experiencing PD failure, frequent peritonitis, or fluid overload, combined PD+HD therapy may serve as a feasible alternative to conventional HD. Careful patient selection and individualized treatment planning are crucial for optimizing outcomes. Given its comparable efficacy to HD, combined PD+HD therapy may represent an important option for patients requiring a tailored approach to dialysis.