PD Dose Needs Adjustment for Activity Level

Is one PD Kt/Vurea level the same in a sedentary older person as it is in an active younger one?  NO, finds a new study that looked at energy expenditure in 148 PD patients. Adjusting Kt for resting energy use showed that women received less PD than men, younger people received less PD than older ones, and working people received less PD than unemployed ones—among other significant differences.

Read the abstract » | (added 2016-10-13)

Tags: Hemodialysis

Exploding PD Myths

Misconceptions about who will be a “good PD patient” have unnecessarily limited PD updake, increased transfers to in-center HD, and raised costs. Get the straight story!

Read the abstract » | (added 2016-09-14)

Tags: Hemodialysis

VIPs in Dialysis Modality Choice

Whose opinion matters most to patients when it comes time to make a dialysis decision? In New Zealand, at least, it’s the nephrologist—even though respondents thought it would be predialysis nurses. In fact, a 1-point increase in nephrologist decisional power increased the rate of home therapies by 6.1%.

Read the abstract » | (added 2016-09-14)

Tags: Hemodialysis

Considering Alternative Markers for Dialysis Dose

A new review article looks at the impact of longer and/or more frequent, high-dose HD on dialysis adequacy—and inadequacy. Some uremic solutes come from nutrient intake and others don’t. For nutrient-based solutes, the authors suggest using inorganic phosphorus and protein-bound wastes as markers to develop new dose measures. For non-nutrient based middle molecules, they suggest beta-2-microglobulin measurement.

Read the abstract » | (added 2016-09-14)

Tags: Hemodialysis

Personal Support Workers for Home HD

Oh, Canada. The Canadians are out ahead of the US in virtually every dialysis parameter and they innovate constantly. Now, they have introduced a concept that CMS threw out with the bathwater in the 1980s—assisted home HD. A pilot project to dialyze six patients at home with personal support workers projected that costs would still be lower than for in-center HD. Phase 2 of the project includes 8 hospitals and 67 patients.

Read the abstract » | (added 2016-09-14)

Tags: Hemodialysis

French Patients on Daily HD

Daily HD is relatively new to France—yet this study was able to include 753 patients who started on the therapy between 2003 and 2012. Two-thirds had switched to daily HD from another option. Younger patients (<64) had better survival (72.6% vs. 31%) and were more likely to receive a kidney transplant than older patients (>64).

Read the abstract » | (added 2016-08-09)

Tags: Hemodialysis

Which is More Cost Effective, PD or Standard In-Center HD?

If you’ve been reading this site, you won’t be surprised to learn that yet another study has found PD to be more cost-effective than standard in-center HD. A cross-sectional analysis was done on matched pairs of incident PD and HD patients (N=4,285) in Taiwan who were followed for up to 14 years. While the quality-adjusted life expectancy was almost equal, HD costs were much higher.

Read the abstract » | (added 2016-08-09)

Tags: Hemodialysis

PD or In-Center HD: Which is Better for Transplant?

An analysis of 12 studies found that doing PD before a transplant had significanlty less delayed graft function than those who did standard in-center HD. While on dialysis, PD had better 5-year survival than standard HD, too. There were no differences in the rates of acute rejection or transplant survival. Watch a Video Journal Club of this study on 'Cappuccino with Claudio Ronco'

Read the abstract » | (added 2016-07-12)

Tags: Hemodialysis

Nocturnal HD Improves Nutritional Status

A metaanalysis was conducted of 9 studies with 229 patients who switched from standard to nocturnal HD. Those on nocturnal HD had significantly higher levels of serum albumin and protein and energy intake.

Read the abstract » | (added 2016-07-12)

Tags: Hemodialysis

Independence, Flexibility and Quality of Life Matter to Patients

For the PCORI-funded Empowering Patients on Choices for Renal Replacement Therapy (EPOCH-RRT), 180 people not yet on dialysis or using standard HD or PD were interviewed to identify the factors in their choice of a dialysis option. Independence, quality and quantity of life, and daily schedule flexibility mattered most—and 47% of those on standard HD said the choice had not been theirs. (NOTE: Ironically, the EPOCH-RRT decision aid omits home HD, an option that offers independence, quality of life, better survival, and schedule flexibility, as we have blogged here and here).

Read the abstract » | (added 2016-07-12)

Tags: Hemodialysis