letter to the editor

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Figure 1 | Three groups were matched with age, gender, underlying disease, and prevalence of cardiovascular disease. The cumulative survival rate did not differ significantly between groups (log-rank P = 0.20).

technique survival for some PD patients by permitting those struggling to maintain adequate solute and water clearance to continue PD. A single weekly HD session could optimize dialysis for marginal PD patients, including larger patients, low transporters, and those without significant residual renal function. The downside of CPD would be the requirement for dual PD and vascular access, potentially increasing risk of infection. Alternatively, the presence of an arteriovenous graft or fistula would ease the transition to HD when the time came for a permanent switch. In the United States and countries with diverse demographics, larger observational studies are needed to determine whether CPD would be an acceptable alternative to PD or HD alone, and to determine whether CPD is associated with a survival benefit. 1.

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In 2013, approximately 1900 patients (20% of all PD patients) were receiving this therapy in Japan (Japanese Society for Dialysis Therapy, unpublished data). CPH may increase the indications for PD in the United States. 1.

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Kumar VA, Sidell MA, Jones JP et al. Survival of propensity matched incident peritoneal and hemodialysis patients in a United States health care system. Kidney Int 2014; 86: 1016–1022. Matsuo N, Yokoyama K, Maruyama Y et al. Clinical impact of a combined therapy of peritoneal dialysis and hemodialysis. Clin Nephrol 2010; 74: 209–216. Kimura K, Ogura M, Yokoyama K et al. A reason for choosing peritoneal dialysis: lessons after the Japan earthquake and the Fukushima nuclear accident. Am J Kidney Dis 2012; 60: 327.

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Matsuo N, Yokoyama K, Tanno Y et al. Combined therapy using peritoneal dialysis and hemodialysis may increase the indications for peritoneal dialysis in the United States. Kidney Int 2015; 87: 1267–1268. Agarwal M, Clinard P, Burkart JM. Combined peritoneal dialysis and hemodialysis: our experience compared to others. Perit Dial Int 2003; 23: 157–161.

Victoria A. Kumar1, Margo A. Sidell2, Jason P. Jones2 and Edward F. Vonesh3 1 Division of Nephrology, Department of Internal Medicine, Southern California Permanente Medical Group, Los Angeles, California, USA; 2Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California, USA and 3Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA Correspondence: Victoria A. Kumar, Division of Nephrology, Department of Internal Medicine, Southern California Permanente Medical Group, 4700 Sunset Boulevard, Los Angeles, California 90027, USA. E-mail: [email protected].

Kidney International (2015) 87, 1260; doi:10.1038/ki.2015.55

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Nanae Matsuo , Keitaro Yokoyama , Yudo Tanno , Izumi Yamamoto1 and Takashi Yokoo1 1

Division of Nephrology and Hypertension, Department of Internal Medicine, Tokyo, Japan Correspondence: Keitaro Yokoyama, Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University Schoool of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8471, Japan. E-mail: [email protected] Kidney International (2015) 87, 1259–1260; doi:10.1038/ki.2015.56

The Authors Reply: We thank Matsuo et al.1 for their comment regarding combined peritoneal and hemodialysis (CPD). The simultaneous use of peritoneal (PD) and hemodialysis (HD) offers a viable solution in emergency situations and may afford potential benefits to a subgroup of PD patients2. The current US shortage of PD solutions has been a challenge for PD programs, many of which have struggled to place new patients on PD in the latter half of 2014. CPD could have alleviated the situation by permitting flexibility in the dialysis prescription for new and existing patients. CPD could be considered a self-care dialysis option augmented by in-center HD. It could potentially increase 1260

Regarding mini-review on bicarbonate therapy for prevention of chronic kidney disease progression To the Editor: The mini-review on bicarbonate therapy for prevention of chronic kidney disease progression1 was a much-needed, well-written, and informative review. It has long been known that chronic acidosis seen in chronic kidney disease (CKD) 4 and 5 has a deleterious effect on digestion and general nutrition. The recommendation of rigorous treatment to prevent progression of CKD was well explained by various recently reported pathophysiological mechanisms that support the urgency of treatment. However, there was a recommendation in the management that is a cause of concern. Because of the probability of poor compliance and intolerance with administration of NaHCO3 compounds, the authors recommend other alkali products—e.g., Shohl’s solution (sodium citrate and citric acid) or polycitra (citric acid, potassium citrate, and sodium citrate)—as alternatives. They do issue a warning of the dangers of increased Kidney International (2015) 87, 1258–1264

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