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Part 4: Technical Advances in PD |
Tsuchiya General Hospital, Hiroshima, Japan
Correspondence to: H. Kawanishi, Tsuchiya General Hospital, 3-30 Nakajimacho,
Naka-ku, Hiroshima 730-8655
Japan.
h-kawanishi{at}tsuchiya-hp.jp
The fundamental objective of dialysis is to maintain the dose of solute
clearance and ultrafiltration (UF). When peritoneal dialysis (PD) patients
cannot maintain target clearances, the dialysis dose needs to be increased.
The means of increasing dose by PD alone are limited, especially in patients
with UF failure. Combination therapy with PD and hemodialysis (PD+HD) is the
simplest way to solve this problem. The general prescription for PD+HD should
be 5-6 days of PD and 1 session of HD weekly. To determine the adequacy of
PD+HD, we adopted the equivalent renal clearance (EKR), transforming the
weekly Kt/V from PD and then evaluating the total clearance from both
modalities.
The weekly PD+HD regimen improves clinical status in patients in whom PD
alone does not result in dialysis adequacy, and it permits a substantial
prolongation of PD. The complementary effects of PD and HD improve clinical
status and prognosis in patients undergoing dialysis; we therefore propose to
use the term "complementary dialysis" for this technique.
KEY WORDS: KEY WORDS:; Combination therapy; hemodialysis; complementary dialysis; adequacy.
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