Maruyama Yukio
Contrib Nephrol. 2018;196:64-70. doi: 10.1159/000485701. Epub 2018 Jul 24.
Peritoneal dialysis (PD) is recommended as first-line renal replacement therapy for end-stage renal disease. Combined therapy with PD and hemodialysis (HD) is an option for patients on PD with inadequate dialysis and/or fluid overload that has rapidly gained popularity in Japan.
The clinical benefits of combined therapy have been recognized. After switching from PD alone to combined therapy, there is a decrease in body weight, blood pressure, and serum creatinine, as well as an increase in the hemoglobin level, suggesting significant improvement in dialysis and decreased fluid overload. Further, there is a decrease in the dialysate-to-plasma ratio of creatinine, which is obtained from the peritoneal equilibration test and is known to be an independent risk factor for encapsulating peritoneal sclerosis, suggesting improved functioning of the peritoneal membrane. Several studies found that survival in patients on combined therapy was similar to or better than that in patients on PD or HD. Key Messages: Combined therapy with PD and HD is becoming widespread in Japan; however, its clinical benefits, especially in terms of morbidity and mortality, have not been validated. Furthermore, no criteria for initiation or discontinuation of combined therapy have been established, mainly because the previously published studies have been retrospective, single-center studies with small sample sizes that performed before-and-after comparisons only. Prospective cohort studies are needed to validate the use of combined therapy with PD and HD.
腹膜透析（PD）被推荐作为终末期肾病的一线肾脏替代治疗方法。对于腹膜透析不充分和/或存在液体超负荷的患者，腹膜透析与血液透析（HD）联合治疗是一种选择，在日本已迅速普及。
联合治疗的临床益处已得到认可。从单纯腹膜透析转换为联合治疗后，体重、血压和血清肌酐下降，血红蛋白水平升高，提示透析显著改善且液体超负荷减轻。此外，腹膜平衡试验得出的肌酐透析液与血浆比值降低，已知该比值是包裹性腹膜硬化的独立危险因素，提示腹膜功能改善。多项研究发现，联合治疗患者的生存率与腹膜透析或血液透析患者相似或更好。关键信息：腹膜透析与血液透析联合治疗在日本正逐渐普及；然而，其临床益处，尤其是在发病率和死亡率方面，尚未得到验证。此外，尚未确立联合治疗开始或停止的标准，主要是因为先前发表的研究均为回顾性、单中心、小样本研究，仅进行前后比较。需要进行前瞻性队列研究以验证腹膜透析与血液透析联合治疗的应用。
