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Abstract: FR-OR110

Combination of Once Weekly Hemodialysis with Peritoneal Dialysis Is Associated with Lower Mortality Compared with Peritoneal Dialysis Alone: A Longitudinal Study

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Tagawa, Miho, Nara Medical University, Nara, Japan
  • Hamano, Takayuki, Osaka University Graduate School of Medicine, Suita, OSAKA-FU, Japan
  • Abe, Masanori, Nihon University School of Medicine, Tokyo, Japan
  • Masakane, Ikuto, Honcho-Yabuki Clinic, Yamagata, Japan
Background

Combination of once weekly hemodialysis with peritoneal dialysis is a unique type of renal replacement therapy available in Japan. Outcomes of this therapy compared with peritoneal dialysis alone has not been reported in a large cohort.

Methods

This is a longitudinal study based on Japanese Renal Data Registry (JRDR). Those on peritoneal dialysis from 2010 to 2014 in the JRDR database were included. The end of observation period was at the end of 2015. Exposure of interest was combination of once weekly hemodialysis with peritoneal dialysis compared with peritoneal dialysis alone. Outcomes were all-cause mortality, cardiovascular mortality, and death due to congestive heart failure. Those who initiated combination therapy from 2011 to 2014 were matched with those on peritoneal dialysis alone by propensity score derived from the data of previous year. The data were analyzed using Kaplan-Meier curves and Cox regression models.

Results

Six hundred and eight patients on combination therapy were matched with 869 on peritoneal dialysis alone. During median follow-up of 2.5 years, there were 224 death, 123 cardiovascular death, and 35 death due to congestive heart failure. All-cause mortality (HR [95% CI]: 0.56 [0.42-0.75]), cardiovascular mortality (HR: 0.48 [0.32-0.72]), and death due to congestive heart failure (HR: 0.19 [0.07-0.55]) were significantly lower among combination therapy group. Transition to hemodialysis was significantly earlier in combination therapy group (HR: 1.72 [1.46-2.04]). There was no effect modification by age, dialysis vintage, diabetic status, or baseline urine volume. The decrease in body weight was larger in combination group (p<0.001 by mixed effects model) in combination therapy group, suggesting better fluid removal.

Conclusion

Combination of once weekly hemodialysis with peritoneal dialysis was associated with lower mortality compared with peritoneal dialysis alone.