Combined XXXX and hemodialysis: our experience compared to others.

@entity1 @entity2313 @entity16 @entity298 @entity454
OBJECTIVE: To determine the clinical experience of using combined-modality [simultaneous hemodialysis (HD) and @entity298 ( @entity298 )] treatment in @entity1 with @entity454 . DESIGN: We reviewed data on 4 @entity1 from our center that were treated with "combined-mode therapy." We then conducted a retrospective survey by sending questionnaires to nephrologists in the US and Canada by mail and by posting the survey on the Internet. Data queried included number of @entity1 on combined modality, solute clearances, @entity2313 levels pre and post combined therapy, reasons for using combined therapy, duration and success of combined therapy, and reimbursement issues. SETTING AND @entity1 : Ours is a tertiary-care center. @entity1 that were not doing well on @entity298 alone were put on combined modality of treatment between 1992 and 1998. MAIN OUTCOME MEASURES: Clinical improvement in the indication for which the @entity1 was started on combined modality. RESULTS: In response to the survey, data on 27 @entity1 were collected. These data were combined with data on 4 @entity1 from our unit that had previously been treated with combined HD and @entity298 . Most @entity1 were reported to have more than one clinical reason for changing from @entity298 to combined therapy. The main clinical reason for offering combined treatments was inadequate solute clearance (34%), followed by ultrafiltration problems (16%) and @entity16 (11%). Mean duration of time followed on combined treatment was 8.5 +/- 0.12 months. Most @entity1 tolerated combined treatment well and were reported to show improvement in the clinical reasons for which they needed the combined modality. Dual access and reimbursement issues were not a problem. There was no single method used for calculating total (HD, @entity298 , and residual renal) solute clearance. No universal total solute clearance goal was reported. CONCLUSION: Hemodialysis and @entity298 are not mutually exclusive. They can be used in combination to achieve targeted solute clearances, to improve certain clinical conditions, and to control volume and blood pressure in a subset of @entity1 . Further evaluation is needed to better establish the long-term outcomes of using combined modality. Total solute clearance goals and methods for determining total solute clearance need to be standardized.
