1
Whether Hemodialysis Would Improve Kidney 20% in 6 Months V.s Peritoneal
Dialysis: Literature Review
Student’s Name
Professor
Institution
Course
Date
2
Whether Hemodialysis Would Improve Kidney 20% in 6 Months V.s Peritoneal
Dialysis: Literature Review
Introduction
The care of patients with ESRD has been a topic of interest in nephrology for quite a
while now, with the two main approaches to treatment being HD and PD. In recent studies, an
attempt has been made to compare the effectiveness of these methods and the results of patients'
improvement and quality of life (Lee et al., 2019). Of particular concern is the possibility of a
gradual enhancement of kidney functioning by the indicated dialysis procedures. So, this
literature review aims to reveal up-to-date data comparing the efficacy of HD and PD regarding
the six-month improvement of kidney function. This literature review considers the findings of
contemporary investigations to discuss the claim based on which it was stated that, compared to
PD within this period, HD could enhance renal function to the extent of 20%.
Methods of Searching
The articles for the study were collected from databases and through manual search to
include only peer-reviewed sources that came out within the last five years. The main databases
that were used for this study were the PubMed, CINAHL, and Google Scholar databases.
Keywords used were: (hemodialysis OR peritoneal dialysis) AND (comparative study OR kidney
function) AND (dialysis outcomes) only articles published in English and from the years 2019–
2024. Moreover, the bibliographies of the articles that were identified in the study were also
reviewed to enhance the search. The initial search generated over 200 articles, and finally, 25
related articles were selected for the systematic review on improvement in kidney function in HD
versus PD. Out of the 133 papers identified on the basis of screening, five high-quality papers
3
were subsequently included in the present review based on the assessment of their relevance to
the research question and quality.
Review of the Literature
In their population-based study in Korea, Lee et al. (2019) compared the clinical
outcomes of patients with PD and those with HD. In their study, they were able to source data
from a nationwide health insurance database that gave a more accurate picture of dialysis
outcomes. Thus, indicating lower all-cause mortality of PD as compared to HD patients in the
early stage of dialysis. In this study, longer periods were compared, and HD offered improved
survival outcomes in the long term. Notably, the extent of change in function was not evaluated
in the study, but the overall patient outcomes were; the latter might be indicators of kidney health
(Lee et al., 2019). The authors also pointed out that although PD and HD are both options for
ESRD treatment, their choice should be based on patient PECs.
For cardiovascular mortality, the study by Ng et al. (2021) was designed to compare
solely the outcomes of treatment between the selected groups, namely, HD and PD patients. In
their meta-analysis of cohort studies, they concluded that, on average, PD was found to cause
fewer cardiovascular deaths than HD during the first two years of treatment. But this advantage
was not all that much continued in the future, or, as it can be said, in the long run. Although this
study was not exactly identifying how to enhance kidney function, it described the
cardiovascular effects that are related and dependent on the type of dialysis, which is considered
an essential factor in overall kidney health (Ng et al., 2021). The authors stressed that the
underlying reasons for these differences in cardiovascular events remain undocumented and
require more research.
4
Banshodani et al. (2020) conducted a study on comparing dialysis modality with
cardiovascular diseases. According to their study, when compared to patients on HD, PD patients
had a significantly reduced risk of cardiovascular events, especially in the early stages of
dialysis. The authors pointed out that this could explain the above difference in terms of
prognosis by stating the possibility of better preservation of residual renal function in patients
with PD (Banshodani et al., 2020). After a discussion of the respective results in detail, this result
supports the hypothesis in an indirect way that PD could have a more positive effect on kidney
function in the short term. However, the study also revealed that the benefit of PD decreased
over time (Lee et al., 2019; Ng et al., 2021).
Kim et al. (2020) had a contrasting approach by evaluating the eating habits of both
groups of participants with either HD or PD. Although their study did not involve the direct
assessment of the kidney function of the patients, it gave researchers an understanding of some
of the factors that may affect the kidneys in addition to the examination of the effectiveness of
dialysis in the patients. It was discovered that PD patients were more compliant with the fluid
restrictions compared to the dietary restrictions in comparison to HD patients. These different
diets could influence the outcomes of each of the forms of dialysis in terms of enhancing kidney
function or otherwise. Based on the findings, the authors made the recommendation that
individualized nutritional education interventions might improve the effects of both peritoneal
and hemodialysis approaches (Kim et al., 2020).
Moreover, Dias et al. (2021) investigated the complication rate and the outcomes for both
PD and HD in the setting of urgent-start dialysis. According to their work, they noted that,
compared with PD, there were significantly fewer complications and improved residual renal
function in the primordial stages of the treatment. This finding is specifically important in the
5
context of this study as it addresses a question about the improvement of kidney function. PD
might maintain this function in a better way than HD and maybe even better than no treatment at
all in terms of short-term outcomes (Dias et al., 2021). However, the study assumed urgent-start
settings only, and therefore, the evidence may not be directly generalizable to all dialysis
patients.
Findings
Several findings have been established from the current literature regarding the
differential impact of both diseases in relation to their impact on the kidney and the prognosis of
the patients. Firstly, there seems to exist the element of time, as far as the efficacy of these
dialysis modalities is concerned. The outcomes across the subsequent months have been
evaluated in several studies, such as Lee et al. (2019) and Ng et al. (2021), that demonstrated PD
has certain benefits in the initial period of the treatment related to mortality and cardiac events.
However, these advantages are often less pronounced in the long term, where HD appears to
have a superior longer-term outcome in some contexts. This temporal pattern could mean that the
effect on GFR may also be changing over time, possibly making PD more appropriate in the
short term but HD in the long run.
Secondly, studies suggest that maintaining the RR (residual renal) function becomes one
of the significant predictors of patients on dialysis. Banshodani et al. (2020) and Dias et al.
(2021) stated that PD may have added usefulness in the preservation of residual kidney function,
and this was likely true in the early phase of PD treatment. This information supports the
hypothesis of the study, in which one of the modalities was supposed to provide a more
significant benefit regarding kidney function. Though it can be seen that the authors of all the
reviewed experimental studies did not report actual enhancement of kidney function up to 20%
6
as it was hypothesized in all reviewed articles, The effect on kidney function appears less and
less clearly cut, as it is affected by the cardiovascular status, diet, or patient’s profile, among
others.
Conclusion
Consequently, this literature review synthesis has explored the prospects of using
hemodialysis and peritoneal dialysis to enhance kidney functionality. Although the reviewed
literature does not support the claim that HD would enhance kidney function by 20% as
compared to PD within six months, it has given some useful information about the impact of the
two modes of dialysis. The literature review indicates that PD may produce short-term benefits in
terms of the conservation of residual renal function and myocardial and vascular injuries that can
have a positive impact on the kidneys, notably via the mitigation of the consequences of
dyslipidemia (Banshodani et al., 2020). The durability of the results obtained with the use of HD,
revealing benefits for patients in the long term, indicates the possible effectiveness of this
method in achieving a steady improvement in kidney functions. Future studies should directly
quantify the changes in kidney function over time as well, relating to both dialysis techniques, to
answer the particular hypothesis made in this article in more detail.
7
References
Banshodani, M., Kawanishi, H., Moriishi, M., Shintaku, S., & Tsuchiya, S. (2020). Association
between dialysis modality and cardiovascular diseases: a comparison between peritoneal
dialysis and hemodialysis.CBlood Purification,C49(3), 302-309.
Dias, D. B., Mendes, M. L., Caramori, J. T., Falbo dos Reis, P., & Ponce, D. (2021). Urgent-start
dialysis: Comparison of complications and outcomes between peritoneal dialysis and
haemodialysis.CPeritoneal Dialysis International,C41(2), 244-252.
Kim, S. M., Kang, B. C., Kim, H. J., Kyung, M. S., Oh, H. J., Kim, J. H., ... & Ryu, D. R. (2020).
Comparison of hemodialysis and peritoneal dialysis patients’ dietary behaviors.CBMC
nephrology,C21, 1-11.
Lee, S. W., Lee, N. R., Son, S. K., Kim, J., Sul, A. R., Kim, Y., ... & Ryu, D. R. (2019).
Comparative study of peritoneal dialysis versus hemodialysis on the clinical outcomes in
Korea: a population-based approach.CScientific reports,C9(1), 5905.
Ng, C. H., Ong, Z. H., Sran, H. K., & Wee, T. B. (2021). Comparison of cardiovascular mortality
in hemodialysis versus peritoneal dialysis.CInternational Urology and Nephrology,C53,
1363-1371.
C
