Kt/V Urea Should NOT Be Used as an Adequacy Measure for PD

Since the National Cooperative Dialysis Study, PD adequacy attention has focused on urea clearance, rather than on the more important benefit of middle molecule clearance. In this opinion piece, Dr. Joanne Bargman asserts that the PD community “made a mistake” adopting urea kinetics to the peritoneal dialysis process,” an error that continues to this day despite the lack of evidence linking Kt/V to outcomes in PD patients.

Read the abstract » | (added 2016-05-12)

Tags:

Urea Alone is Not a Good Index of Dialysis Dose

All-cause mortality in the HEMO study was not significantly related to removal of small solutes in short, intermittent, standard HD. “Failure to achieve greater reductions in solute levels may explain the failure of high Kt/V urea treatment to improve outcomes,” the authors note. (Yet another reanalysis of the HEMO study data has confirmed the obvious…)

Read the abstract » | (added 2016-04-12)

Tags: Hemodialysis

Kidney to Kidney: 2008K@Home and NxStage System One

Among home HD patients followed for a year, there were a few differences between users of the 2008K@Home and the NxStage System One. 2008K@Home users did not do treatments as often—but their mean standardized Kt/Vs were significantly higher (2.75 vs. 1.99). System One users tended to use less EPO. Other outcomes and lab test values were largely similar.

Read the abstract » | (added 2016-03-10)

Tags: Hemodialysis

Metaanalysis: Better PD Catheter Outcomes Via Laparoscope

An analysis of five randomized trials and 11 cohort studies compared laparoscopic PD catheter placement to surgery. The laparoscopic approach had less catheter migration and the catheters lasted longer, though there was a slightly higher risk of bleeding.

Read the abstract » | (added 2016-03-10)

Tags:

Meta-Analysis: Longer Dialysis, Better Pregnancy Outcomes

A new metaanlysis analyzed 190 papers and 25 abstracts covering 681 pregnancies in 647 women on dialysis. Meta-regression analysis found that more hours of HD per week was associated with a lower rate of preterm delivery, and that more dialysis sessions per week was associated with larger birthweight babies. Case reports suggested fewer small for gestational age babies with HD than with PD. No increased risk of birth defects was found.

Read the abstract » | (added 2015-12-10)

Tags:

Excessive Weight Gain in Year 1 of PD Predicts Poor Outcomes

In a PLoS One study, 148 incident PD patients were observed for a median of almost 2 years. Those who gained more than 3% of their body weight lost residual kidney function 4.17 times faster (p<0.001), and had higher blood pressure, more inflammation, and an increased rate of diabetes.

Read the abstract » | (added 2015-10-15)

Tags:

Outcomes of “integrated home dialysis” (PD then home HD)

What happens to people after PD fails—and why not plan to get them home on HD? Researchers in Australia and New Zealand looked at this model using ANZDATA registry data. Those treated with PD only (n=168) had the highest risk of technique failure and death, while those who did only home HD or who transitioned from PD to home HD fared much better.

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

Tags: Home dialysis

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)

Tags:

Metaanalysis: PD fluid with fewer GDPs improves outcomes

Glucose degradation products (GDPs) are known to damage the delicate peritoneum. PD fluids with neutral pH and low levels of GDPs were reviewed in a new study of 11 randomized controlled trials (n=643). While most of the studies were of poor quality, low-GDP PD fluid was better at preserving residual kidney function and urine volume for a year than standard PD fluid.

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

Tags:

On PD, motivation matters

With the changes in the bundle, more people are being started on PD. In a study of 104 people on PD followed for 14 months, nurse ratings of home cleanliness or patients’ exchange techniques did not predict outcomes. Instead, unmotivated or depressed people were significantly more likely to have peritonitis.

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

Tags: Peritonitis