Journal Watch
Outcomes in Urgent- vs. Early-Start PD
A study defining urgent-start PD (US-PD) as within 72 hours of catheter placement and early start (ES-PD) as 3 and 14 days later compared 72 patients in both groups. Both groups were comparable re: demographics, 30-day complications, 6-month hospitalizations, and PD dropout. US-PD patients were more prone to leakage.
Read the abstract » | (added 2020-07-10)
Tags: Peritoneal Dialysis, Disease Patients, Clinical Characteristics
PD Catheter Placement Outcomes: Urgent- vs. Elective-start
After analyzing 13 years of data comparing urgent-start (n=29) and elective-start (n=211) PD, the only significant difference between the mostly-comparable groups was a higher incidence of catheter leaks. Complication and catheter removal rates at 3 and 12 months were similar, as were days to first complication and 12-month patient survival. Catheter placement technique did not affect the outcomes.
Read the abstract » | (added 2020-05-12)
Outcomes Between Urgent-start PD and HD
Urgent-start PD (n=93) and urgent-start HD (n=91) patients similar in age, diabetes and other comorbidities, and lab values, were followed for 6 months to 2 years. Rates of mechanical complications, bacteremia, and survival were comparable. Exit site/access infections were significantly higher in the PD patients, but those on PD had significantly better residual kidney function and phosphorus control, and used significantly less erythropoietin and antihypertensives
Read the abstract » | (added 2020-04-13)
Tags: Haemodialysis, Renal Function Recovery, Peritoneal Dialysis, Urgent Start
PD Outcomes under the Medicare Expanded Dialysis Prospective Payment System
A Medicare change in 2011 may have increased the likelihood that clinics would expand PD to a broader population. Did this affect outcomes? A prospective cohort study compared 10,585 patients who started PD before payment reform, 7,832 interim patients, and 18,742 during the reform period. With similar demographics, more patients were treated in clinics with less PD experience—and these clinics had higher PD discontinuation rates. But, PD discontinuation fell overall, and mortality risk was stable.
Read the abstract » | (added 2019-10-14)
Tags: Expanded Dialysis Prospective Payment System, PD, Medicare
Home Dialysis: Better Outcomes at Lower Costs
Five years after starting dialysis, the population of Ontario, Canada over age 18 had mean 30-day PD costs 50% lower than in-center HD—and home HD costs 64% lower than in-center. After adjusting for covariates, home HD cost the least and had the highest survival (80%) vs. 52% on PD and 42% on in-center HD.
Read the abstract » | (added 2019-10-14)
Tags: Home Dialysis, PD Cost, HD Cost, HD Survival
KDIGO Controversies: Dialysis Start and Modality Choice
A January 2018 Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference addressed significant variations between countries in dialysis start, patient preparation, and modality mix. Happily, attendees supported individualized care that incorporates patient goals and preferences (within quality and safety parameters), and the need to avoid a one-size-fits-all approach.
Read the abstract » | (added 2019-05-15)
Tags: Modality, Individualized Care, Patient Goals, Patient Preferences
Most Cost Effective Dialysis Options: Metaanalysis
An analysis of 16 economic studies from both high- and low-income countries determined that home dialysis options are less costly and offer comparable—or better—health outcomes than in-center HD. Quality of life concerns were rarely investigated, however.
Read the abstract » | (added 2019-02-14)
Tags: Economic Studies, HD, Cost, Dialysis Options, Health Outcomes
Low-volume Tidal PD for Urgent Starts
A randomized, prospective trial was done to see if tidal PD (TPD) would improve outcomes among 27 urgent start PD patients, vs. 22 who did low-volume intermittent PD. After follow up for up to 2 years, the TPD group did have significantly fewer catheter complications. Both options had about the same technique survival.
Read the abstract » | (added 2019-01-11)
Tags: Automated Peritoneal Dialysis, Tidal Peritoneal Dialysis, Intermittent Peritoneal Dialysis, Complications
Metaanalysis of PD for Kidney Failure due to PKD
Polycystic kidneys may displace room for PD fluid, so can PD be a viable treatment option? A metaanalysis of 12 studies and more than 17,000 patients found…maybe. PD outcomes were about the same for those with PKD as with other primary kidney diseases, and some can do PD. More research is needed to determine who is suitable. Read the abstract.
Read the abstract » | (added 2018-10-12)
Tags: Dialysis Adequacy, PD associated Complications, Peritoneal Dialysis, Polycystic Kidney Disease
Urgent Start PD + Diabetes
A retrospective study compared the first 30-day outcomes and survival trends of 80 urgent start dialysis patients, 50 of whom (62.5%) did PD. Compared to those who started standard in-center HD, the dialysis-related complications were significantly lower for those on PD, and PD survival was higher as well. Read the abstract.
Read the abstract » | (added 2018-10-12)
Tags: Diabetes, Survival Trends, Urgent Start Dialysis, PD, In center HD, Dialysis related Complications