Journal Watch
Home vs. In-center HD Outcomes from a Matched Cohort
After adjusting for BMI, smoking, race, and comorbidities, home HD came out ahead of in-center HD when 181 home HD patients were matched to 413 using in-center HD. With home HD, the risk of death was significantly less, and phosphate levels were significantly lower. There were no major differences in transplant rates, graft survival, hemoglobin, calcium, or PTH levels.
Read the abstract » | (added 2021-06-15)
Tags: Dialysis Modality; End stage Kidney Disease; Haemodialysis, Hemodialysis, Home Haemodialysis, Home Hemodialysis, Mortality
PD vs. Standard In-Center HD for Stroke Risk: A 14-year Study
Of 7,916 ESRD patients with atrial fibrillation between 2001 and 2013, data from 363 PD and 5,302 HD patients were analyzed. At 1 year, 3 years, and 5 years, the participants who used PD had significantly lower risks for outcomes including stroke, major bleeding, and intracranial hemorrhage than those using HD.
Read the abstract » | (added 2021-06-15)
Tags: ESRD, End Stage Renal Disease, Atrial Fibrillation, Peritoneal Dialysis, Hemodialysis, Patient Outcomes
Better Technique Survival with Assisted PD
A study of 384 PD patients in China compared the outcomes of 274 who did self-care PD with 110 who had assisted PD. Older age, diabetes, low residual kidney function and low serum albumin predicted higher mortality, as did assisted PD, since this group had more comorbidities. Technique failure was also significantly lower in the assisted PD group.
Read the abstract » | (added 2021-04-16)
Outcomes and Costs of Assisted PD
As many as half of those who could use PD need assistance to do so, and many countries outside the U.S. offer this. A narrative review found no differences in quality of life, hospitalization, or mortality between PD and in-center HD patients after adjusting for age and frailty. Nurse assistance may result in better technique survival than family assistance. Assisted PD was still significantly less costly than in-center HD in Canada and Western Europe.
Read the abstract » | (added 2021-03-09)
Tags: Assisted Peritoneal Dialysis, Barriers, Cost, Hemodialysis, Peritoneal Dialysis, Pd
Benefits of Remote PD Monitoring
Compared to 38 standard care PD patients, 35 who received remote monitoring (RM) for 6 months had better outcomes despite higher Charlson Comorbidity scores. The RM group lived further from the clinic or had mobility issues, but were more satisfied with their care, and they had fewer emergency room visits and nephrology-related hospitalizations.
Read the abstract » | (added 2020-12-10)
Tags: Quality Of Life, Remote Monitoring
Warming PD Fluid to Body Temperature Does Not Improve Clearance
There may not be a clear benefit to warming PD fluid to body temperature, suggests a small (N=18) single blind randomized controlled trial. Participants were assigned to have a peritoneal equilibrium test with fluid at 37°C or warmed with conventional methods. The two groups had similar outcomes for peritoneal clearance, abdominal discomfort, body temperature, blood pressure, and other parameters.
Read the abstract » | (added 2020-11-12)
Complications in Planned vs. Unplanned Peritoneal Dialysis Starts
A metaanalysis of 14 papers totalling 2,401 PD patients looked at the outcomes and safety of unplanned PD starts within 7 days of catheter placement vs. 7-14 days. Early-start PD was linked with more leaks, omental wrap, and—for CAPD—catheter malposition. There were no significant differences in infectious complications, but the risk of transition to HD and mortality were higher. More studies are needed.
Read the abstract » | (added 2020-11-12)
International Use of PD
Worldwide PD use is approximately 11%, which varies across the globe, finds a new survey of stakeholders in 182 countries (with 313 respondents from 160 countries). Median PD use was 38.1 per million. Thirty countries, mainly low-income, did not offer PD, while in 69% of countries, PD was the first modality for <10% of incident patients. The range of PD costs passed on to patients was 1-25%, with higher co-pays in South Asia and low-income countries. Patient-reported PD outcomes were rarely measured.
Read the abstract » | (added 2020-09-11)
International Use of HD—Including Home HD
A new survey of stakeholders in 182 countries (with respondents from 160 countries) found a use rate for HD of 298.4 per million. Among incident dialysis patients, the HD rate was 98.0. Standard in-center HD was available among 27% of low-income countries (and these patients paid more of the costs); home HD was available in 36% of high-income countries. Monitoring of patient-reported outcomes was done in 61% of countries, while 60% monitored bone minerals and patient survival, and 51% monitored technique survival. Just 5% of countries initiated patients on HD with arteriovenous access.
Read the abstract » | (added 2020-09-11)
Tags: Hemodialysis, Homedialysis, HD
Converting In-center HD Patients to Home: the Importance of Belief
A small, cross-sectional study (n=44) interviewed patients who were and were not considering home HD. Only 68% of patients said they’d heard about the benefits of home HD. The cohort who were willing to consider it were significantly more likely to believe that self-care and home HD would improve their quality of life, particularly travel, better health outcomes, and the comfort of being at home.
Read the abstract » | (added 2020-09-11)
Tags: Home Hemodialysis, Hemodialysis, Homedialysis, HD