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Kidney Week

Abstract: TH-PO313

Hybrid Dialysis in Peritoneal Dialysis Patients with Low Solute Clearance or Volume Overload: Two Years' Experience

Session Information

  • Home Dialysis - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Hussain, Mohammed Ezzat, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
  • Elgaali, Musab, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
  • Alkadi, Mohamad M., Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
  • Ali, Ahlam Bushra, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
  • Aly, Sahar, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
  • Ahmed, Hanaa, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
  • Hamad, Abdullah Ibrahim, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
  • Al-Malki, Hassan A., Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
Background

ESRD patients on PD prefer this modality because it allows them greater flexibility related to timing, a better lifestyle, and fewer dietary restrictions compared to HD. With the reduction in residual renal functions, the largest applicable PD regimen might not be enough to achieve adequate solute clearance or fluid removal. In such circumstances, convincing some patients to shift completely to hemodialysis is usually difficult. We started a Hybrid Dialysis (HyD) prescription for these patients by keeping them on PD 6 days per week and an HD session once per week. The safety and efficacy of HyD were evaluated.

Methods

Identified all PD patients with either low solute clearance or inadequate ultrafiltration despite using the maximum applicable PD regimen.
They were referred to vascular surgeons for hemodialysis access then arranged HD slots .
We enrolled eighteen patients from May 2021 till April 2023. All of them were kept on once-weekly hemodialysis for 3-4 hours plus PD 6 days per week. We evaluated volume status clinically, Pre-HD urea, potassium, phosphorus, and bicarbonate as indicators of solute clearance, and Albumin level as an indicator of nutritional state. In addition, dialysis-related Emergency Department visits and dialysis access-related infection rates after starting hybrid dialysis were also observed.

Results

Volume status significantly improved associated with a reduction in mean systolic blood pressure, (169 ± 32 Vs 135± 15 mmHg, p < 0.0001) and around a 5 % drop in mean dry weight.
All solute clearance indicators showed significant improvement with HyD, reductions in mean urea by 36.7% (27.5 ± 8 vs 18.4 ± 7 mmol/L) p-value < 0.001, mean potassium by 23.52% p-value <0.0001 and mean phosphorus reduction of 26.5 % p-value <0.01. The rise in mean bicarbonate was by 15.6 % p-value <0 .001. Improvement of mean serum albumin from 26 ± 6 gm/L to 30 ± 7 gm/L p-value < 0.05. No ED visits or dialysis access-related infections were reported.

Conclusion

Hybrid dialysis is a safe , effective, and reasonable dialysis modality in PD patients with either volume-overloaded or low solute clearance. associated with an improved nutritional state & better control of BP.