Hybrid dialysis: Two modalities twice the benefit?

Peritoneal dialysis (PD) is a preferred dialysis modality in many patients and healthcare settings, as it enables patient independence, reduces hospital visits, and health costs when compared to center-based hemodialysis (HD). However, PD technique failure due to loss of residual kidney function and/or loss of peritoneal membrane function may require patients to transition to HD, where hybrid dialysis (combining PD and HD) may be a viable alternative to thrice-weekly HD, while also promoting patient-centered care. However, hybrid dialysis is not advocated in current clinical practice guidelines, potentially due to a lack of clinician experience or high certainty evidence on the benefits, safety, and cost of combining PD and HD. In this narrative review, we summarize the existing data on health and economic outcomes in patients transitioning from PD alone to combined PD and HD, which may inform patient selection, dialysis prescription, and evaluation of dialysis quality for clinicians and patients considering hybrid dialysis.