2003 Volume 36 Issue 1 Pages 73-79
HD+PD combination therapy, in which two differing therapeutic methods (hemodialysis and peritonealdialysis) are combined, is associated with a problem of defining the amount to be dialyzed. In the current study, the amount to be dialyzed during HD+PD combination therapy was evaluated as the mass of creatinine that is removed per week (Mw: Mass of creatinine removed per week). Creatinine clearance of 60L/week or 1.73m2 is commonly considered associated with satisfactory prognosis for peritoneal dialysis patients. Therefore, the corresponding amount of creatinine removed per week was designated as the ideal mass of creatinine to be removed (ideal Mw); and the therapeutic procedure by which body weight gain was kept within 5% of the dry weight and 3kg per week when the ideal Mw was achieved was defined as the most appropriate dialysis procedure. The amount of creatinine removed per week by the residual kidney function and that by hemodialysis were determined. For the mass of creatinine removed by peritoneal dialysis, the predicted amounts of creatinine and water that would be removed were computed through simulation using peritoneal function analysis software PDAdequest, ver. 2.0; and when possible, a prescription by which the total amount of creatinine removed per week may exceed the ideal Mw was adopted. The ideal Mw could be computed with this software 2.0. A therapeutic plan was prepared and applied to 2 patients for whom treatment was shifted from hemodialysis to HD+PD combination therapy. During hemodialysis, there were no weight gains in excess of 3Kg or dangerous increases on clinical test results during the time allowed for peritoneal recovery. However, it was strongly suggested that the dialysis effect may not be sufficient if the number of days allowed for peritoneal recovery is increased. The amounts of water and creatinine removed through peritoneal dialysis that had been predicted by the therapeutic plan generally coincided with the actual values. It is thought that the method for therapeutic pianning described here is relatively convenient and effective.
