Timing of PD—is an early start harmful?

Early start HD (when eGFR is >10.5 mL/min/1.73m2) is not helpful, and may even be harmful. Is the same true of PD? No, suggests an observational study of 8,047 incident PD patients in Canada. Overall mortality was not higher for early, middle, or late start PD. However, first-year mortality was 38% higher in the early start group than in the late start group.

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

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High-sensitivity CRP levels predict technique and patient survival on PD

High C-reactive protein (CRP) levels suggest inflammation. Among 402 PD patients followed for 2 years, those with the lowest CRP levels were more likely to still be on PD and had better survival. Each 1 mg/L increase in CRP predicted a 1.4% higher risk of mortality.

Read the abstract » | (added 2014-04-09)

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Phosphate is a blood vessel toxin

If blood phosphate levels are too high, the blood vessels can turn to stone—even in children. Heart damage from high phosphate levels can begin in pre-dialysis CKD. "Keeping serum P levels in the normal range reduces cardiovascular risk and mortality," say the authors. [Editor's note: nocturnal hemodialysis removes the most phosphate of any dialysis option.]

Read the abstract » | (added 2013-05-24)

Tags: Chronic kidney disease

Mortality patterns in PD & home HD differ from standard in-center HD

In the Australian dialysis database (ANZDATA), 4,298 deaths on PD and 10,338 on HD were analyzed for patterns. Patients who did PD, home HD, or in-center HD more than 3 days per week were equally likely to die on any day of the week. Not so for standard in-center HD patients: they were significantly more likely to die from heart-related reasons on Monday, after the 2-day no-treatment weekend.

Read the abstract » | (added 2013-02-27)

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Community house home hemodialysis in Australia and New Zealand

Not everyone who wants to dialyze at home is able to. In Australia and New Zealand unstaffed, non-medical community homes fill a gap to make "home" treatments possible. This observational study compared mortality among 113 community home dialyzers to 5,591 people on PD, 1,532 on home HD, and 5,647 on in-center HD. Community house HD was safe and effective.

Read the abstract » | (added 2012-12-19)

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Longer or more-frequent HD normalizes mortality patterns

It has long been known that those on PD have an equal chance of dying on any day of the week—while standard in-center HD are much more likely to die on a Monday (or Tuesday with Tue-Thu-Sat treatments). A new study looking at 14,636 Australian registry deaths found that those who got more than 3 standard in-center treatments per week or did home HD were no more likely to die on a Monday (or Tuesday) than any other day.

Read the abstract » | (added 2012-09-25)

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Metaanalysis: Later dialysis start is better for HD

Starting dialysis at a lower GFR allows more time for access placement and options education. But the U.S. trend has been to start earlier. A new metaanalysis of 17 studies found that starting dialysis at a higher GFR was linked with a significantly higher risk of all-cause mortality—in HD, but not PD. The mortality risk was lower when GFR was calculated than when it was estimated.

Read the abstract » | (added 2012-08-16)

Tags: Chronic kidney disease

Home HD and mortality risk in Australia and New Zealand

Researchers analyzed data from 26,016 patients in the ANZDATA registry (856,007 patient-months) to see if home HD helped people live longer. Compared to standard in-center HD, those on standard (3x/week), more-frequent, or nocturnal home HD were about twice as likely to survive.

Read the abstract » | (added 2011-08-25)

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87 people on nocturnal home HD for 12 years had just 30% the mortality of standard HD

How does survival of people on nightly home HD compare to those in the USRDS? A single-center study of 87 people who got 40±6 hours a week of HD found that 79% lived 5 years, and 64% lived for 10 years—a mortality rate just 30% of the USRDS average. Higher levels of education and more hours of dialysis were the only factors independently linked with survival.

Read the abstract » | (added 2011-04-25)

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Travel time to HD predicts HRQOL, adherence, & death

A new paper from the Dialysis Outcomes and Practice Patterns (DOPPS) study of 20,994 patients reports that patents whose one-way travel to HD was longer than 60 minutes had significantly higher mortality and lower quality of life. Patients noted, "I feel as if it rules all my time." The authors suggest home dialysis as an option for those who live far from the nearest center.

Read the abstract » | (added 2011-02-24)

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