Unphysiology is Back and Affects the Heart in Standard HD

It’s been quite a while since “unphysiology” appeared in a journal article title. The authors note that the intermittent nature of in-center HD causes significant upward and downward fluctuations that affect fluid status, add to hemodynamic instability, and increase cardiovascular risk. More frequent HD modalities, on the other hand, can reduce left ventricular hypertrophy, improve BP control, and possibly boost survival, and PD is more continuous and gentle.

Read the abstract » | (added 2024-11-21)

Tags: Unphysiology, In center HD, Fluid Status, Hemodynamic Instability, Cardiovascular Risk, HD, PD

Pet Cats and Peritonitis—a Non-starter for PD?

The answer might surprise you. In a retrospective registry study in France, 52 PD patients who developed cat-related peritonitis were matched with 208 controls whose PD peritonitis was due to other causes. After analysis, pet-related peritonitis had lower risks of death or transfer to HD and a higher rate of transplant than other-cause peritonitis. The authors concluded that, while cats may cause peritonitis, having pets at home should not be considered a reason to refuse patients PD.

Read the abstract » | (added 2024-11-21)

Tags: Pets, Cats, Peritonitis, Pet related Peritonitis, PD, Technique Survival

Staying Infection-free with PD and Home HD

While home treatments tend to be better treatments, infection is still a risk—and prevention a necessity. Education and inclusion of infection-prevention in training are important, as are managing modifiable risk factors, such as constipation, gastric acid blockers, and hypokalemia in PD. For home HD, reducing CVC use and duration and using the rope ladder technique for cannulation can reduce risk.

Read the abstract » | (added 2024-11-21)

Tags: Infection prevention, Modifiable Risk Factors, PD, HHD, Central Venous Catheters, CVC

Is There a Best Practice for PD Exit Site Care to Prevent Infection?

In a systematic review and meta-analysis, 2,092 studies were examined and 13 comprising 1,229 PD patients were selected for analysis (9 RCTs, 3 quasi-experimental, and one self-controlled trial). Five types of exit site care dressings were compared: named disinfection, antibacterial, non-antibacterial occlusive, sterile gauze, and no-particular dressings. No dressing was more effective than any other for preventing exit site infections or peritonitis.

Read the abstract » | (added 2024-08-16)

Tags: Systematic Review, Meta analysis, PD, Exit Site Infection. Peritonitis

Startling Proportion of Patients Chose PD or Home HD After a Dialysis Start Unit

The University Health Network of Toronto examined the uptake of home dialysis between 2013 and 2021 among patients who started in a “Dialysis Start Unit” (equivalent to a transitional care unit in the U.S.). Of 122 patients, 68 (55.7%) chose either PD (57; 46.7%) or home HD (11; 9%).

Read the abstract » | (added 2024-07-12)

Tags: Home Hemodialysis, HHD, Peritoneal Dialysis, PD, Dialysis Start Unit

Personalized PD Prescriptions

Urea alone is not able to assess dialysis adequacy. Rather than a focus on removing a single toxin, a more holistic, person-centered approach is emerging to improve well-being and minimize treatment burden—based on clinical outcomes and patient experiences of care. This approach requires close collaboration between patients and care teams and eliciting patient goals, priorities, and preferences. This paper reviews the evidence for a patient-centered approach to PD.

Read the abstract » | (added 2024-06-14)

Tags: Urea, Dialysis Adequacy, Treatment Burden, Patient centered Care, PD

Mineral Bone Disease (MBD) and Survival on PD

A P-DOPPS study analyzed MBD data from more than 12,000 patients from eight countries. The results revealed a U-shaped curve for the relationship between PTH and mortality, with the lowest risk at PTH levels of 300-599 pg/mL. Serum calcium levels higher than 9.6 mg/dL were associated with a 20% increase in mortality as well. Major country variations in MBD treatment were identified.

Read the abstract » | (added 2024-04-12)

Tags: Mineral Bone Disease, MBD, PTH, Mortality, Serum Calcium Levels, PD

New Nomogram Predicts Roxadustat Treatment Failure in Anemic PD Patients

A retrospective analysis of 204 anemic PD patients from 2019 to 2023 was used to construct a predictive nomogram of Roxadustat success. Duration of PD, serum transferrin, cardiovascular comorbidities and stains were significant predictors. The nomogram was more predictive at 12 months than at 6 months.

Read the abstract » | (added 2024-04-12)

Tags: Roxadustat, HIF inhibitor, Treatment Failure, Anemia, PD

Comprehensive Health Education and PD

Among 98 PD patients randomly assigned to routine care or a full-course health education program, the full-course group had significantly higher health behavior and treatment adherence scores. They were more likely to take their medications correctly and had better quality of life and fewer hospital readmission rates than controls.

Read the abstract » | (added 2024-04-12)

Tags: Peritoneal Dialysis, PD, Comprehensive Health Education, Education Program, Quality Of Life

Impact of Prior Abdominal Procedures on Peritoneal Dialysis Catheter Outcomes: Findings From the North American Peritoneal Dialysis Catheter Registry

A history of prior abdominal procedures may influence the likelihood of referral for peritoneal dialysis (PD) catheter insertion. To guide clinical decision making in this population, this study examined the association between prior abdominal procedures and outcomes in patients undergoing PD catheter insertion.

Read the abstract » | (added 2024-03-15)

Tags: Dialysis, PD, PD Catheter Outcomes, End Stage Kidney Disease, Peritoneal Dialysis, Prior Abdominal Surgery