Impact of the START Project on PD in Canada

In Alberta, Canada, the Starting dialysis on Time, at home, on the Right Therapy (START) project enrolled 1,962 consecutive adult ESKD patients who started dialysis between April 1, 2015 and March 31, 2018 with the aim of increasing the proportion of patients who do PD within 6 months of dialysis start. At baseline, 27% of incident patients tarted PD. Immediately after implementation, there was a 5.4% increase in the use of PD. No changes were found in rates of hospitalization, death, or probability of switching to HD.

Read the abstract » | (added 2024-03-15)

Tags: Haemodialysis, Peritoneal Dialysis, Quality Improvement

High Ultrafiltration Volumes May Contribute to Pruritus

Could changes in skin perfusion and inflammation play a role in dialysis itching? An observational study of 392 patients looked at self-reports of pruritus severity and UF volumes. BMI and UF volume independently predicted pruritis severity.

Read the abstract » | (added 2023-12-15)

Tags: Ultrafiltration Volume, UF Volume, BMI, Pruritus, Skin Perfusion, Inflammation

The Varied Uses of Assisted PD in Spain

In a retrospective look from 1997 through 2020, a Spanish clinic identified four groups who used assisted PD at some point. Group 1 was totally dependent at PD start, group 2 was self-care and then became totally dependent, group 3 needed short-term PD help, and group 4, the controls, remained on self-care. Of those who required assistance, 73% did so during follow up, not initially. Up to 44% of autonomous patients became dependent for various reasons over time, including loss of a care partner. Assisted PD—even when paying care partners—was less costly than switching to standard HD.

Read the abstract » | (added 2022-10-17)

Tags: Assisted PD, Dependency

PD Adequacy and Itching

Among 80 people on CAPD, blood levels of the pain marker “substance P” and total urea clearance both independently predicted itching. Inadequate PD seems to be a reason for people using PD to itch.

Read the abstract » | (added 2021-07-12)

Tags: Pruritus , Peritoneal Dialysis, CAPD, Substance P, Total Urea Clearance, Itching, PD

Starting with PD Better than Switching to it from HD

A metaanalysis comparing patients who started with PD to those who began HD and then switched to PD after 3 months found significantly better overall and technique survival in the PD first group. There were no significant differences in the peritonitis rate.

Read the abstract » | (added 2020-07-10)

Tags: Hemodialysis, Peritoneal Dialysis, Renal Replacement Therapy

Metaanalysis of Nocturnal HD and Sleep Quality

Nine studies of 286 patients found significantly less sleep apnea and better O2 saturation—but less total sleep time—after switching from conventional to nocturnal HD. Prospective pre-post studies found improved sleep quality, but randomized trials did not. Read the abstract.

Read the abstract » | (added 2018-10-12)

Tags: Sleep Apnea, CHD, NHD, O2 Saturation, Nocturnal HD, Conventional HD, Sleep Quality

If One PD Exit Site Antibiotic is Good, Are Two Better?

In a single center study, 146 people on PD were randomized to use gentamycin cream on their exit sites (n=71) or to switch between gentamycin in odd months and mupirocin in even months (n=75). After 174 (gentamycin) or 181 patient years (alternating), the group switching between two antibiotics had significantly more peritonitis, especially gram-negative and fungal.

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

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Less Severe Itching With PD Than In-center HD

Among 380 people on PD or in-center HD, fewer on PD had uremic pruritus (itching) (28.6% vs. 38.2%). And, the itching was less severe in those who did PD, and affected less of the body. Those with higher levels of active vitamin D had less intense itching. Those with higher blood levels of phosphorus, triglycerides, and AST had more itching problems.

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

Tags: Hemodialysis

Case Report: Thrombocytopenia with NxStage

Two patients have developed thrombocytopenia while using NxStage dialysis machines, perhaps due to electron-beam sterilization of the dialyzers. Switching to another machine resolved the problem; but it recurred in the patient who retried NxStage.

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

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Nocturnal in-center HD comes to Slovenia

Only a few handfuls of US clinics offer nocturnal in-center HD. Now, Slovenian researchers report their experience of switching 10 patients from "standard" (4-5 hours!) in-center treatments to thrice weekly 8-hour long nighttime ones. With almost twice as much dialysis per week, mean predialysis creatinine and urea dropped significantly, as did mean dry weight. Six of the ten were able to stop taking phosphate binders, and one more patient had a dose reduction—and phosphate was added to the dialysate for three patients. There were no major changes in predialysis blood pressure, calcium or potassium levels, mean ultrafiltration, hemoglobin, or EPO dose (Editor's note: perhaps because standard HD in Slovenia is longer, and because the nocturnal treatments were only three times per week).

Read the abstract » | (added 2013-10-02)

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