Abstract
Clinical Impact of a Combined Therapy of Peritoneal Dialysis and Hemodialysis
Background: Disturbances of fluid status control and anemia have been thought to aggravate the mortality of peritoneal dialysis (PD) patients. After the loss of residual renal function (RRF), there are limitations on how well PD alone can control overhydration. Combined therapy of PD and hemodialysis (C-PDHD) is a treatment for PD patients who cannot control body fluid status or who cannot gain adequate solute removal by PD alone. C-PDHD may also be able to improve renal anemia to remove middle-molecule uremic toxins. The aim of this study was to evaluate the effects of C-PDHD on clinical outcome.
Methods: The study recruited 56 patients on PD who were diagnosed with underdialysis or overhydration, or both, with declining RRF. Parameters of volume control, uremic solute removal, anemia, and predictors for encapsulating peritoneal sclerosis (EPS) were compared before and 1 year after C-PDHD. Moreover, the mortality of patients on C-PDHD was compared with that of patients on PD alone.
Results: The state of body fluids improved significantly, with a reduction in atrial natriuretic peptide and blood pressure. Serum creatinine and β2-microglobulin also decreased significantly. Hemoglobin increased remarkably to 10.7 ± 1.2 g/dL from 8.2 ± 1.6 g/dL (p < 0.01), and the reticulocyte count also increased significantly. The dose of recombinant human erythropoietin administed decreased significantly. The dialysate-to-plasma ratio of creatinine obtained from a fast peritoneal equilibration test (PET) decreased significantly to 0.59 ± 0.13 from 0.65 ± 0.11, and the level of interleukin 6 in PET drainage also declined significantly, both indicators having been reported to be predictors of EPS. Serum C-reactive protein and fibrinogen also declined significantly. Moreover, the mortality of patients on C-PDHD was better than that of patients on PD alone.
Conclusions: C-PDHD is an effective way to control fluid status and to correct inadequate solute removal, with markedly improved renal anemia. By these factors, C-PDHD might improve survival in these patients.
Effect of Self-Efficacy on Fluid Status in Patients on Continuous Ambulatory Peritoneal Dialysis
Objectives: Self-efficacy reflects a person's belief about their ability to complete a given task. Self-efficacy has been reported to be linked to positive clinical outcomes in chronic disease. However, the effect of self-efficacy on fluid status in continuous ambulatory peritoneal dialysis (CAPD) patients (pts) is unknown.
Methods: Our cross-sectional study included 92 adult pts (44.5 ± 13.3 years of age; 56.5% men) who had been on CAPD for more than 3 months (median: 17.3 mos.) and followed for at least 6 mos. at our peritoneal dialysis (PD) center. Fluid status, demographic, clinical, compliance, and self-efficacy data were collected. Bioelectrical impedance was used to evaluate extracellular water (ECW) / total body water (TBW). Based on mean ECW/TBW (0.40 ± 0.14), the pts were allocated to one of two groups: group A (ECW/TBW < 0.40; n = 49) or group B (ECW/TBW ≥ 0.40; n = 43). A peritoneal equilibration test evaluated membrane function, and Kt/V evaluated solute clearance and residual renal function. Self-efficacy was assessed using the Chronic Disease Self-Efficacy Scale, which has been widely used in chronic disease studies.
Results: The primary renal diseases in the study pts were glomerulonephritis (51.1%), diabetes mellitus (DM—18.5%), renal vascular disease (12.0%), and others (18.5%). The mean ECW/TBW in group A was 0.39 ± 0.01; in group B, it was 0.41 ± 0.01 (t = –10.792, p = 0.000). Compared with group A pts, pts in group B were older and had a higher proportion of DM, a shorter duration of PD, lower urine volume and fluid removal, higher dialysate-to-plasma creatinine, lower serum albumin, and more severe edema. Self-efficacy scores 7.00 ± 1.17 in group A and 6.18 ± 1.34 in group B (t = 3.139; p = 0.002). The average self-efficacy score was negatively related to ECW/TBW (r = –0.247, p = 0.018). By logistic regression, the independent predictors of fluid status were self-efficacy [p = 0.006; odds ratio (OR): 0.509; 95% confidence interval (CI): 0.314 to 0.827], serum albumin (p = 0.001; OR: 0.763; 95% CI: 0.647 to 0.900), and age (p = 0.013; OR: 1.054; 95% CI: 1.011 to 1.099). Other fluid status factors such as sex, serum sodium, and compliance were not significantly different between the groups.
Conclusions: Self-efficacy was an independent predictor of fluid status in CAPD pts. To improve fluid status in CAPD pts, particular attention should be paid to enhancing their self-efficacy, so that pts can manage themselves positively and avoid factors related to fluid retention.