Encapsulating Peritoneal Sclerosis Increases with Time on PD

EPS is a devastating PD complication that can be lethal. An Italian clinic looked back at 30 years worth of data and found EPS prevalence rates of 2.8% overall among 920 patients: 0.4% for <2 years of PD, 3% at 2-4 years, 4% at 4-6 years, 6% at 6-8 years, 8% at 8-10 years, 75% by 12-14 years, and 67% for those with 14+ years of PD. Steroid treatment helped reduce mortality.

Read the abstract » | (added 2015-11-11)

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Home HD has 20% lower all-cause mortality than PD

In a new study that matched 4,201 new home HD patients in the USRDS database to new PD patients, the risk of all-cause mortality was 20% lower with home HD. In addition, there was an 8% lower risk of hospitalization, and a 37% lower risk of technique failure.

Read the abstract » | (added 2015-09-11)

Tags: Home dialysis

Brazil APD Survival Significantly Better than CAPD

A prospective study matched each of the incident APD patients in Brazil with a CAPD patient, using 15 matching factors, and looked at mortality, technique failure, and time to first peritonitis. With 1,445 patients each in the APD and CAPD groups, the researchers found 44% higher mortality among CAPD patients, but no differences in technique failure or time to peritonitis.

Read the abstract » | (added 2015-08-08)

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It’s (past) time to avoid 3-day interdialytic intervals

A new review paper considers the ill effects of the thrice weekly standard in-center HD schedule and finds it wanting, noting higher mortality on the day after the long gap than any other day of the week. The authors conclude that the data warrant “reexamining the issue of timing and frequency of prescribed dialysis regimens in order to improve patient outcomes.”

Read the abstract » | (added 2015-07-08)

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Are we finally nearing the end of Kt/V?

We have been vocal critics of Kt/V on Home Dialysis Central since the start—and now we are not alone. A new paper finds that Kt/V is not a good fit for short daily or long nocturnal treatments, to the point where, “urea kinetics are hardly if at all representative for those of other solutes with a deleterious effect on morbidity and mortality of uremic patients.”

Read the abstract » | (added 2015-07-08)

Tags: Nocturnal Hemodialysis

Metanalysis of low-glucose PD fluid and residual kidney function

An analysis of six randomized controlled trials of neutral pH, low-glucose PD fluids has found that patients who used these fluids had a much slower rate of residual kidney function loss and much higher weekly Kt/Vs than those using standard PD fluids. There were no significant differences between groups in ultrafiltration, blood pressure, or all-cause mortality.

Read the abstract » | (added 2015-04-10)

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On PD, less inflammation linked with longer survival

Among 87 people on PD, ages 30-85, who were followed for 30 months, the inflammation marker serum amyloid-A (SAA) was a significant independent predictor of mortality. When four markers of inflammation were analyzed together, SAA, age, and the presence of cerebrovascular insults were the strongest predictors.

Read the abstract » | (added 2015-03-11)

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Is low blood sodium as harmful in PD as it is in HD?

Hyponatremia (low blood sodium levels) raise the risk of death in people who do standard in-center HD. A prospective observational study of 441 incident PD patients found a higher mortality risk among those who did PD, too. In fact, after 3 years, the 1/3 of study participants whose sodium was lowest had a 79% higher risk of death than those whose levels were higher.

Read the abstract » | (added 2014-12-09)

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First-year outcomes of incident US PD patients

Among 1,677 incident PD patients from Fresenius, 367 switched to HD within the first 90 days. Of those who continued with PD, first-year mortality was 10 per 100 patient-years, with 42 episodes of peritonitis and 128 hospitalizations per 100 patient-years. About 2/3 of the hospitalizations occurred in the first 6 months of PD therapy. Of those who switched to HD, 81.4% began treatment with a central venous catheter—and 78.3% still had one 90 days later.

Read the abstract » | (added 2014-07-07)

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Home HD survival in New Zealand

Researchers analyzed 15 years worth of home HD data in NZ (6,419 patients and 20,042 patient-years of follow up). After adjusting for comorbidities, home HD had 52% better survival than in-center HD. PD had 20% better survival than in-center HD in the first 3 years—but a 33% higher mortality risk after that.

Read the abstract » | (added 2014-06-05)

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