New modality of dialysis therapy: peritoneal dialysis first and transition to home hemodialysis.

Recent studies have clearly demonstrated that start ing treatment with peritoneal dialysis (PD) is superior to starting with conventional hemodialysis (HD) because PD preserves residual renal function for a longer period. Similarly, because of the frequency of treatments, home HD (HHD) is also superior to conventional HD. The accumulated evidence suggests that a combination of PD and HHD might be a new and effective method for patients receiving dialysis therapy. We analyzed 10 patients who, over the past 10 years, were started on PD and who were then transferred to HHD. Electronic databases were used to examine changes in their health status. Mean age was 58 +/- 8 years in these 2 female and 8 male patients. Mean duration of PD was 6.9 +/- 2.4 years. The average total duration of dialysis therapy was 9.7 +/- 1.9 years. The main reason for the transition from PD to HHD was loss of residual renal function. To the time of writing, no serious complications (including cardiovascular events and calcium homeostasis) had occurred. All patients continue to receive dialysis therapy and have been able to lead a nearly normal social life. Major laboratory findings include serum albumin 4.2 +/- 0.2 g/dL, hemoglobin 10.2 +/- 1.4 g/dL (half the patients were not using erythropoiesis-stimulating agents), serum creatinine 7.5 +/- 2.5 mg/dL, blood urea nitrogen 36 +/- 17 mg/dL, serum phosphate 4.3 mg/dL. In two thirds of the patients, blood pressure was controlled without antihypertensive agents. No patient had left ventricular hypertrophy. In this analysis, we found that relatively young subjects preferred PD first, with later transfer to HHD; that PD is superior as an introduction to dialysis therapy; that patients starting with PD prefer self medical treatment; and that all patients were free from the various complications that are encountered during long-term dialysis therapy. We suggest that patients who need dialysis therapy consider this new dialysis approach of "PD first and transfer to HHD."