Menoufia Medical Journal

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 32  |  Issue : 3  |  Page : 901--905

Hemodialysis versus peritoneal dialysis: a comparative study Menoufia Medical Journal


Mahmoud Abd El-Aziz Kora1, Ahmad M Zahran1, Khaled M A El-Zorkany1, Ahmad M Ewedah2,  
1 Internal Medicine and Nephrology Department, Faculty of Medicine, Menoufia University, Egypt
2 Internal Medicine Department, Ministry of Health, El-Behira, Egypt

Correspondence Address:
Ahmad M Ewedah
Mohammad Mousa Street, Damanhour, El-Behira
Egypt

Abstract

Objective To compare between dialysis modalities and their effect on anemia control, chronic kidney disease mineral bone disease (CKD-MBD) control, dialysis adequacy, and dialysis complication on end-stage renal disease (ESRD) patients. Background Hemodialysis (HD) and peritoneal dialysis (PD) are dialysis modalities for ESRD patients that have its own effect on patients. Many publications studied the modality effect on ESRD patients, but in Egypt few data was reported about these items. Patients and methods This cross-sectional study was carried out in January 2017 on 82 patients with ESRD maintained on HD and 21 patients with ESRD on PD. HD patients were collected randomly from a pool of HD patients attending regular HD in the Nephrology and Dialysis Department of Damanhour Medical National Institute. The PD patients were collected from the Nephrology and Dialysis Department of Damanhour Medical National Institute (16 patients) and Nephrology and Dialysis Department of New Mansura General Hospital (International) (five patients). A comparison between the two groups regarding anemia control, CKD-MBD, dialysis adequacy, and dialysis complication was performed. Results The PD group was better regarding the target levels of intact parathyroid hormone than HD (61 and 34%, respectively) (P = 0.038) and in the achievement of target Kt/V (90 and 48%, respectively) (P = 0.001). There was no significant difference regarding anemia control or complications. Conclusion PD has a better effect on CKD-MBD and it is easy for the PD patients to achieve adequacy than the HD patients. PD should have more chance as an RRT for the ESRD patients in Egypt.



How to cite this article:
El-Aziz Kora MA, Zahran AM, El-Zorkany KM, Ewedah AM. Hemodialysis versus peritoneal dialysis: a comparative study Menoufia Medical Journal.Menoufia Med J 2019;32:901-905


How to cite this URL:
El-Aziz Kora MA, Zahran AM, El-Zorkany KM, Ewedah AM. Hemodialysis versus peritoneal dialysis: a comparative study Menoufia Medical Journal. Menoufia Med J [serial online] 2019 [cited 2019 Dec 16 ];32:901-905
Available from: http://www.mmj.eg.net/text.asp?2019/32/3/901/268830


Full Text



 Introduction



End-stage renal disease (ESRD) adversely affects a patient's social, financial, and psychological well-being [1].

Among the dialysis patients, the most common problems were related to chronic anemia, bone mineral disease, dialysis adequacy, and complications related to the dialysis process.

Anemia is associated with poor lifestyle, hospitalization rate, and mortality [2].

Chronic kidney disease mineral bone disease (CKD-MBD) is associated with bad general condition, poor quality of life, hospital admissions, cardiovascular morbidity, and mortality [3].

Each dialysis modality need its own requirements for reaching adequacy that some patients may not fulfill. Inadequate dialysis or a low dose of prescribed dialysis will result in impaired life quality, long-term complications, and high mortality risk [4].

Complications related to process dialysis and poor compliance for dialysis modality will lead to bad general condition of patients, hospital admissions, and increased risk for morbidity and mortality.

Although a considerable number of manuscripts about mental and physical health in ESRD patients have been published, there are conflicting results regarding the relationship between dialysis modality and outcome [5].

Hence, the exact relationship between these issues should be examined in hemodialysis (HD) patients and peritoneal dialysis (PD).

Aim

The aim of this study was to compare between dialysis modalities and their effect on anemia control, CKD-MBD control, dialysis adequacy, and dialysis complication on ESRD patients.

 Patients and Methods



This cross-sectional study was carried out in January 2017 on 82 patients with ESRD on maintenance HD and 21 patients with ESRD on PD. The HD patients were collected randomly from a pool of HD patients attending regular HD in the Nephrology and Dialysis Department of the Damanhour Medical National Institute. The PD patients were collected from the Nephrology and Dialysis Department of the Damanhour Medical National Institute (16 patients) and fro the Nephrology and Dialysis Department of New Mansura General Hospital (International) (five patients) and all of them were shifted from HD to PD due to poor vascular access. All participants were given informed consent and the study was approved by the Ethics Committee of Menoufia University.

All patients were subjected to: clinical history taking, personal history (name, age, sex, marital status, and occupation), disease history, medications used for chronic kidney disease, and full clinical examination. Assessment of dialysis modality-related complications (infection, obstruction of access, electrolyte problem, other complications) were made.

Investigations made were of blood urea, serum creatinine, complete blood count (CBC), serum ferritin, transferrin saturation percentage, serum corrected calcium, serum inorganic phosphate, intact parathyroid hormone (iPTH), and calculation of Kt/V.

Statistical analysis of the data

Data were fed to the computer and analyzed using an IBM personal computer and SPSS software package, version 20.0 (IBM in Armonk, New York, United States) [6]. Qualitative data were described using number and percent. Quantitative data were described using mean and SD. Significance of the obtained results was judged at the 5% level. χ2-Test was used for categorical variables, to compare between two studied groups. Student's t-test was used for normally quantitative variables, to compare between two studied groups. Z-test was used for categorical variables, to compare between two studied groups. Mann–Whitney U-test was used for abnormally quantitative variables, to compare between two studied groups.

 Results



Altogether 103 patients were recruited, including 82 HD patients and 21 PD patients. The mean age was 47.79 ± 13.36 years for the HD group and 49.52 ± 11.63 for the PD group. Men were 64.6% among the HD, while in the PD group men were 38.8% (significant difference between the two groups). The mean dialysis durations of HD and PD groups were 7.51 ± 5.31 and 1.76 ± 1.30 years, respectively. The main cause of ESRD was hypertension in the two groups, while unknown etiology was the second category in both groups. Diabetic nephropathy was the third cause of ESRD in both groups. The characteristics of the patients with the two groups are shown in [Table 1].{Table 1}

The CBC results showed no significant differences between the HD group and the PD group considering the CBC, except that there was a significantly lower platelet count among the HD group (P = 0.029). Results showed a significant low levels of serum calcium in the HD group than the PD group (8.7 ± 1.2 and 7.9 ± 1.3, respectively) (P = 0.023). Moreover, serum albumin in patients was 3.5 ± 0.4 g for the HD group and 2.9 ± 0.7 g for the PD group (P = 0.001). However, there was significant difference between the two groups that favors that PD over HD was manifested by a better percentage of patients with target iPTH (2–9-folds of upper level) in the PD group than the HD group (61.9 vs. 34.1%, respectively) (P = 0.038). The results have shown no difference in serum creatinine levels between the two groups. Results have also shown that 90.5% of the PD group managed to achieve their target Kt/V, while in the HD group it was only 48.8% that could achieve it (P = 0.001). Results are shown in [Table 2].{Table 2}

The results have shown no significant differences in complications between the two groups [Table 3].{Table 3}

 Discussion



In the present study, the results have demonstrated that there was no significant difference between the HD and PD groups considering anemia.

A meta-analysis was performed to compare the effect of HD and PD on anemia [7]. There were 11 studies that reported the content of hemoglobin between the HD and PD groups. It showed no significant difference in the hemoglobin content between patients who suffered from HD and PD [7].

In patients with CKD, elevated ferritin is associated with decreased ESA response and a more severe anemia [8]. Totally 10 studies reported the comparison of ferritin between HD and PD. No significant difference of ferritin was found between the HD and PD groups [7]. Our study showed the same results.

Eight publications reported the transferrin saturation index in both HD and PD groups. The transferrin saturation index in both HD and PD groups showed no significant difference [7]. One of the factors involved in dialysis is the blood loss, which makes the patients prone to develop iron deficiency [9].

A proposed other factor, but still unclear, suggested by different studies [10] is that reduced serum albumin level may lead to renal anemia. Nine studies were included in the meta-analysis. The content of serum albumin in the HD group was much more than that in PD group [7] which was also shown in our study.

The role of parathyroid hormone as a uremic toxin on erythropoiesis has been discussed in several studies. It was reported that high levels of serum iPTH are involved in decreasing the survival of red blood cells [11]. There were six studies that reported the compassion of iPTH levels in HD and PD groups. No significant difference was found for iPTH levels between the two dialysis strategies [7]. However in our study, the results revealed that a higher percentage of PD group achieved target levels of iPTH.

Middle molecular-weight solutes were suggested to be responsible for the toxic effect of red blood cells [12]. Previous evidence has proved that ambulatory PD is more efficient in eliminating middle-molecular weight substances and results in lower anemia indices than HD [13]. However, a recent study has indicated that no significant difference was found in red blood cell survival between HD and PD [14]. In the last few years, erythropoiesis-inhibiting factors in the sera of patients with anemia of ESRD, spermine and spermidine, have been described to be responsible for the inhibition of erythropoiesis of uremia. These compounds have a low molecular weight of around 200 Da [15]. In our study, the clearance of small molecules in the PD group is better than the HD group reflected by better target Kt/V achievements.

Our study results have shown that the PD group has better levels of iPTH and CKD-MBD state than the HD group.

It is important to consider the different effects of dialysis types on biochemical markers of CKD-MBD. Serum iPTH levels have good correlations with bone turnover, but their values reflect bone metabolism indirectly [16]. Many authors point at the relationship between serum levels of calcium and P with iPTH in patients on HD and PD [17].

In this study, we found no significant differences in serum phosphorus between patients on HD and PD. The same findings were obtained in other studies [18] as well.

However, there was a significant difference between the HD group and the PD group in serum calcium and serum albumin which were lower in PD than in HD. The most important significant difference is that the PD group was better in CKD-MBD category as the PD group presented better percentage of patient with target level of iPTH as suggested by KDIGO guidelines CKD-MBD 2009 [19] (2–9-folds of upper normal range). Some authors have reported the same findings [20] while others reported the reverse [21].

In our study, HD patients presented a lower percentage of patients achieving target Kt/V than the PD group. It seems that in our study sample it was easier for the PD group to achieve target Kt/V than for the HD group. However, dialysis complications were not significantly different between the HD group and the PD group.

A large number of studies have been performed concerning the relative effect on the mortality of HD versus PD. The results have been conflicting with HD reportedly having no difference, a relative benefit, or a relative adverse effect on survival compared with PD [22].

Multiple studies have found that PD may provide relatively short-term survival benefits [23]. An advantage of short-term but not long-term survival with PD was also noted in a study of incident patients in the USA. Compared with patients undergoing HD, the analysis found that the relative risk of death for PD in nondiabetic and diabetic patients was 0.62 and 0.73 at 3 months, respectively; however, there was no significant difference in risk at 2 years [24].

In a study from Australia and New Zealand, PD was associated with a significantly higher survival at 1 year compared with HD. These benefits were most significant among younger patients without comorbid conditions. After 1 year, however, PD was associated with markedly higher mortality [25].

 Conclusion



The present study demonstrated that both HD and PD patients are different. Our results concluded that the PD patients have better levels of iPTH, better CKD-MBD state, better clearance of small molecules and achieving target Kt/V. Further study will be needed for more analysis of these factors. We also recommend that PD should have more chance as an RRT for the ESRD patients in Egypt.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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