Journal of Nephrology & Therapeutics

Starting with PD Enables Diversity of Later Treatments

Abstract

Hiromichi Suzuki, Hitosi Hoshi, Tsutomu Inoue, Tomohiro Kikuta, Hiroshi Takane, Tsuneo Takenaka and Yumi Kimura

Background: Various reasons for “Peritoneal Dialysis (PD) First” rather than hemodialysis (HD) have been presented, such as better preservation of residual renal function (RRF), longer survival, and lower incidence of hospitalization. In spite of these advantages for “PD First”, in Japan as well as in the United States the annual rate of patients receiving PD has been reduced to less than 10%. One of the major reasons against selecting PD is that a large proportion of PD patients are transferred from PD to HD in less than 5 years. Our “PD First” policy is based on the diversity of modalities available after discontinuing PD therapy. The purpose of this study was to examine the follow-up of patients who selected “PD First” as the initial treatment of end-stage renal disease (EDRD) between April 1997 and December 2010.
Methods: Sex, age, primary underlying diseases and selection of modalities were collected retrospectively.
Results: A total of 377 (59.2 ± 8.3 years old; female/male: 255/122) patients were introduced to PD therapy as “PD First.” Patients who were very old, with cardiovascular problems, senile dementia, and neoplasms that were forced to select PD were excluded. One hundred and sixty patients started HD as complementary dialysis therapy and then continued with PD + HD in combination until transfer to HD, transplantation or home HD. Among them, 10 patients received transplants and 22 patients were transferred to home HD. One hundred and twenty eight patients were switched from PD to HD for various reasons. Overall patients’ survival after 5 and 10 years was 84.8% and 55.8%, respectively.
Conclusion: Our data shows a diversity of modalities for selection after discontinuing PD therapy alone, as well as providing a rationale to support PD as the initial renal replacement modality for end-stage renal disease patients.