Additional intermittent peritoneal dialysis in difficult-to-treat hemodialysis patients with severe heart disease
DOI:
https://doi.org/10.25796/bdd.v8i1.85793Keywords:
additional intermittent peritoneal dialysis, bimodal dialysis treatment, dialysis-related complications, heart failure, hemodialysis, peritoneal dialysisAbstract
Usually, patients treated by peritoneal dialysis are switched to full-time hemodialysis due to technique failure. Sometimes, hemodialysis can be added to peritoneal dialysis to improve dialysis delivery. It can be difficult to use hemodialysis on patients with significant heart disease (valvular disease or ischemic cardiomyopathy) and severe heart failure due to common immediate complications and intradialytic hypotension that may worsen cardiac function, thus closing the vicious cycle of cardiac dysfunction and ischemia. This can result in poor dialysis delivery along with volume overload despite regular hemodialysis sessions. Here, we describe a case series of difficult-to-treat hemodialysis patients (7 males aged 51–73) with significant cardiac comorbidities and heart failure in whom additional intermittent peritoneal dialysis was reintroduced on top of regular hemodialysis. They all were initially treated by peritoneal dialysis (median duration of peritoneal dialysis treatment was 16 months, range 2–44) and then switched to full-time hemodialysis due to insufficient ultrafiltration or reasons unrelated to ultrafiltration, but thereafter, they faced significant hemodialysis-related complications and volume overload despite regular weekly sessions. Peritoneal dialysis (one manual exchange) was reintroduced (2–4 months after switching to full-time HD) on 3 hemodialysis-free days, and patients were followed up. After 12 months, better volume management (regression of pleural effusion, a reduction in water body mass composition (median of 1 vs. 2.4 L), reduced serum NT-proBNP values (median of 13,030 vs. 45,384 pg/ml)), better cardiac functional status, and a reduction in the frequency and number of dialytic complications were achieved. Moreover, during the 12-month follow-up, such bimodal treatment resulted in improved health-related quality of life as assessed by the WHOQoL-BREF questionnaire (median of 74 vs 55). The addition of peritoneal dialysis in difficult-to-treat hemodialysis patients may result in benefits despite additional costs and burdens for patients.
References
Flythe, J. E., & Watnick, S. (2024). Dialysis for Chronic Kidney Failure: A Review. JAMA, 332(18), 1559–1573. https://doi.org/10.1001/jama.2024.16338 DOI: https://doi.org/10.1001/jama.2024.16338
Chuasuwan, A., Pooripussarakul, S., Thakkinstian, A., Ingsathit, A., & Pattanaprateep, O. (2020). Comparisons of quality of life between patients underwent peritoneal dialysis and hemodialysis: a systematic review and meta-analysis. Health and quality of life outcomes, 18(1), 191. https://doi.org/10.1186/s12955-020-01449-2 DOI: https://doi.org/10.1186/s12955-020-01449-2
Auguste, B. L., & Bargman, J. M. (2023). Peritoneal Dialysis Prescription and Adequacy in Clinical Practice: Core Curriculum 2023. American journal of kidney diseases : the official journal of the National Kidney Foundation, 81(1), 100–109. https://doi.org/10.1053/j.ajkd.2022.07.004 DOI: https://doi.org/10.1053/j.ajkd.2022.07.004
Luyan, G., Haixia, Z., Sheng, F., Gang, S., Jing, Z., Ying, L., Linsen, J., Kai, S., Zhi, W., & Huaying, S. (2022). Regression of Left Ventricular Hypertrophy in Patients Combined with Peritoneal Dialysis and Hemodialysis. International journal of clinical practice, 2022, 2652380. https://doi.org/10.1155/2022/2652380 DOI: https://doi.org/10.1155/2022/2652380
Pajek, J., Hutchison, A. J., Bhutani, S., Brenchley, P. E., Hurst, H., Perme, M. P., Summers, A. M., & Vardhan, A. (2014). Outcomes of peritoneal dialysis patients and switching to hemodialysis: a competing risks analysis. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 34(3), 289–298. https://doi.org/10.3747/pdi.2012.00248 DOI: https://doi.org/10.3747/pdi.2012.00248
Chung, M. C., Yu, T. M., Wu, M. J., Chuang, Y. W., Muo, C. H., Chen, C. H., Chang, C. H., Shieh, J. J., Hung, P. H., Chen, J. W., & Chung, C. J. (2020). Is combined peritoneal dialysis and hemodialysis redundant? A nationwide study from Taiwan. BMC nephrology, 21(1), 348. https://doi.org/10.1186/s12882-020-01989-1 DOI: https://doi.org/10.1186/s12882-020-01989-1
Fukui, H., Hara, S., Hashimoto, Y., Horiuchi, T., Ikezoe, M., Itami, N., Kawabe, M., Kawanishi, H., Kimura, H., Nakamoto, Y., Nakayama, M., Ono, M., Ota, K., Shinoda, T., Suga, T., Ueda, T., Fujishima, M., Maeba, T., Yamashita, A., Yoshino, Y., … PD + HD Combination Therapy Study Group (2004). Review of combination of peritoneal dialysis and hemodialysis as a modality of treatment for end-stage renal disease. Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy, 8(1), 56–61. https://doi.org/10.1111/j.1526-0968.2004.00107.x DOI: https://doi.org/10.1111/j.1526-0968.2004.00107.x
Maruyama, Y., Yokoyama, K., Nakayama, M., Higuchi, C., Sanaka, T., Tanaka, Y., Sakai, K., Mizuiri, S., Otsuka, Y., Kuriyama, S., Maeba, T., Iwasawa, H., Nakao, T., Hosoya, T., & EARTH (Evaluation of the Adequacy of Renal replacement THerapy) study group (2014). Combined therapy with peritoneal dialysis and hemodialysis: a multicenter retrospective observational cohort study in Japan. Blood purification, 38(2), 149–153. https://doi.org/10.1159/000368389 DOI: https://doi.org/10.1159/000368389
McCullough, P. A., Chan, C. T., Weinhandl, E. D., Burkart, J. M., & Bakris, G. L. (2016). Intensive Hemodialysis, Left Ventricular Hypertrophy, and Cardiovascular Disease. American journal of kidney diseases : the official journal of the National Kidney Foundation, 68(5S1), S5–S14. https://doi.org/10.1053/j.ajkd.2016.05.025 DOI: https://doi.org/10.1053/j.ajkd.2016.05.025
Puttagunta, H., & Holt, S. G. (2015). Peritoneal Dialysis for Heart Failure. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 35(6), 645–649. https://doi.org/10.3747/pdi.2014.00340 DOI: https://doi.org/10.3747/pdi.2014.00340
Zuidema, M. Y., & Dellsperger, K. C. (2012). Myocardial Stunning with Hemodialysis: Clinical Challenges of the Cardiorenal Patient. Cardiorenal medicine, 2(2), 125–133. https://doi.org/10.1159/000337476 DOI: https://doi.org/10.1159/000337476
Selby, N. M., & McIntyre, C. W. (2011). Peritoneal dialysis is not associated with myocardial stunning. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 31(1), 27–33. https://doi.org/10.3747/pdi.2010.00007 DOI: https://doi.org/10.3747/pdi.2010.00007
Chionh, C. Y., Clementi, A., Poh, C. B., Finkelstein, F. O., & Cruz, D. N. (2020). The use of peritoneal dialysis in heart failure: A systematic review. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 40(6), 527–539. https://doi.org/10.1177/0896860819895198 DOI: https://doi.org/10.1177/0896860819895198
Morelle, J., Stachowska-Pietka, J., Öberg, C., Gadola, L., La Milia, V., Yu, Z., Lambie, M., Mehrotra, R., de Arteaga, J., & Davies, S. (2021). ISPD recommendations for the evaluation of peritoneal membrane dysfunction in adults: Classification, measurement, interpretation and rationale for intervention. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 41(4), 352–372. https://doi.org/10.1177/0896860820982218 DOI: https://doi.org/10.1177/0896860820982218
Assimon, M. M., & Flythe, J. E. (2017). Definitions of intradialytic hypotension. Seminars in dialysis, 30(6), 464–472. https://doi.org/10.1111/sdi.12626 DOI: https://doi.org/10.1111/sdi.12626
Lam, C. S. P., & Solomon, S. D. (2021). Classification of Heart Failure According to Ejection Fraction: JACC Review Topic of the Week. Journal of the American College of Cardiology, 77(25), 3217–3225. https://doi.org/10.1016/j.jacc.2021.04.070 DOI: https://doi.org/10.1016/j.jacc.2021.04.070
Skevington, S. M., Lotfy, M., O’Connell, K. A., & WHOQOL Group (2004). The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 13(2), 299–310. https://doi.org/10.1023/B:QURE.0000018486.91360.00 DOI: https://doi.org/10.1023/B:QURE.0000018486.91360.00
Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. (1998). Psychological medicine, 28(3), 551–558. https://doi.org/10.1017/s0033291798006667 DOI: https://doi.org/10.1017/S0033291798006667
Yang, S. C., Kuo, P. W., Wang, J. D., Lin, M. I., & Su, S. (2005). Quality of life and its determinants of hemodialysis patients in Taiwan measured with WHOQOL-BREF(TW). American journal of kidney diseases : the official journal of the National Kidney Foundation, 46(4), 635–641. https://doi.org/10.1053/j.ajkd.2005.06.015 DOI: https://doi.org/10.1053/j.ajkd.2005.06.015
Joshi, U., Subedi, R., Poudel, P., Ghimire, P. R., Panta, S., & Sigdel, M. R. (2017). Assessment of quality of life in patients undergoing hemodialysis using WHOQOL-BREF questionnaire: a multicenter study. International journal of nephrology and renovascular disease, 10, 195–203. https://doi.org/10.2147/IJNRD.S136522 DOI: https://doi.org/10.2147/IJNRD.S136522
Khan, M. S., Ahmed, A., Greene, S. J., Fiuzat, M., Kittleson, M. M., Butler, J., Bakris, G. L., & Fonarow, G. C. (2023). Managing Heart Failure in Patients on Dialysis: State-of-the-Art Review. Journal of cardiac failure, 29(1), 87–107. https://doi.org/10.1016/j.cardfail.2022.09.013 DOI: https://doi.org/10.1016/j.cardfail.2022.09.013
Ueda, A., Nagai, K., & Yamagata, K. (2021). Preserved peritoneal function by short-term two-day peritoneal rest in hemodialysis combination therapy patients. Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs, 24(2), 296–300. https://doi.org/10.1007/s10047-020-01215-7 DOI: https://doi.org/10.1007/s10047-020-01215-7
Wu, B., Zhao, H., Zuo, L., Liu, A., Lu, L., Qiao, J., Chu, X., Men, C., & He, Y. (2024). Short-term peritoneal rest reduces peritoneal solute transport rate and increases ultrafiltration in high/high average transport peritoneal dialysis patients: a crossover randomized controlled trial. Clinical kidney journal, 17(9), sfae251. https://doi.org/10.1093/ckj/sfae251 DOI: https://doi.org/10.1093/ckj/sfae251
Full Text:
Submitted
Accepted
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Dragan Klarić, Marta Klarić , Jagoda Nikić , Nikola Zagorec
This work is licensed under a Creative Commons Attribution 4.0 International License.
