Journal Watch
Mineral Bone Disease (MBD) and Survival on PD
A P-DOPPS study analyzed MBD data from more than 12,000 patients from eight countries. The results revealed a U-shaped curve for the relationship between PTH and mortality, with the lowest risk at PTH levels of 300-599 pg/mL. Serum calcium levels higher than 9.6 mg/dL were associated with a 20% increase in mortality as well. Major country variations in MBD treatment were identified.
Read the abstract » | (added 2024-04-12)
Tags: Mineral Bone Disease, MBD, PTH, Mortality, Serum Calcium Levels, PD
Short Daily HD, Muscle Strength, and Bone Health
A cross-sectional study compared a variety of parameters between 86 conventional HD patients and 92 short daily HD patients. The short daily HD patients had significantly higher serum albumin levels, Kt/V, and bone mineral density, required significantly fewer ESAs, and had lower phosphorus, inflammation, and PTH levels than conventional HD patients. Short daily HD patients also had significantly higher scores on the 6-minute walking test, stronger hand grips, lower fasting blood sugars, and higher hemoglobin levels.
Read the abstract » | (added 2024-02-07)
Tags: Bone Mineral Density, Conventional Haemodialysis, End stage Kidney Disease, Inflammation, Muscle Function, Short daily Haemodialysis
Can People do Urgent Start PD and Intermittent PD?
Yes. Among 169 people starting PD urgently, 111 had fewer than four exchanges per day (intermittent) and 58 received full-dose PD. A year later, both groups had adequate PD and similar peritoneal transport, residual kidney function, blood pressure control, anemia management, and correction of bone minerals. Infections, complications, and technique survival were similar as well.
Read the abstract » | (added 2022-04-18)
Tags: Urgent Start PD, Incremental Peritoneal Dialysis, USPD, IPD
Can Urgent PD Starts Use Incremental PD?
In a retrospective study of 169 people who began PD, 111 started with incremental PD, while the remaining 58 began full-dose PD. Both groups were similar at the start. After 1 year, the full-dose group was on a higher PD prescription and had significantly higher PD adequacy numbers. Residual kidney function, blood pressure, anemia, and bone mineral correction were similar in both groups.
Read the abstract » | (added 2022-01-14)
Tags: Incremental PD, Full dose PD, PD Prescription, PD Adequacy, Urgent start Peritoneal Dialysis, Residual Kidney Function
Italians Improve on Daily Home HD
As in the U.S., the Italian Ministry of Health has home dialysis as a primary objective. In a 2-year study of seven people switched to six times per week daily home HD, significant improvements began to appear almost immediately. After 3-6 months, bone mineral balance and blood pressure were better, PTH levels and use of phosphate binders dropped, and the participants needed less rhEPO.
Read the abstract » | (added 2021-11-12)
Tags: Home Dialysis, Daily Home HD, RhEPO, Mineral Balance, Blood Pressure, PTH Levels
Impact of Exercise on Bone Mineral Density in PD
Does exercise improve bone density in PD patients as it does in those who use HD? No, finds a small new pilot study of 53 people on PD who were randomly assigned to home exercise (n = 26) or usual care (n = 27). While home exercise significantly improved results on the 30 second sit-to-stand test, 6-minute walk test, and physical activity level, it did not change lumbar spine or hip DEXA results.
Read the abstract » | (added 2021-04-16)
PD and Bone Mineral Disorders vs. HD
Body composition, nutritional status, DEXA, and bone mineral disease (BMD) biomarkers were assessed at baseline and one year in 242 ESRD patients starting either PD (n=138) or HD (n=104). Among HD patients, BMD decreased significantly—but not in PD patients. Preservation of BMD was associated with significantly lower all-cause mortality, with cortical bone preservation more predictive than trabecular bone preservation.
Read the abstract » | (added 2020-09-11)
Tags: End stage Renal Disease, Bone Mineral Density, Dialysis
International Use of HD—Including Home HD
A new survey of stakeholders in 182 countries (with respondents from 160 countries) found a use rate for HD of 298.4 per million. Among incident dialysis patients, the HD rate was 98.0. Standard in-center HD was available among 27% of low-income countries (and these patients paid more of the costs); home HD was available in 36% of high-income countries. Monitoring of patient-reported outcomes was done in 61% of countries, while 60% monitored bone minerals and patient survival, and 51% monitored technique survival. Just 5% of countries initiated patients on HD with arteriovenous access.
Read the abstract » | (added 2020-09-11)
Tags: Hemodialysis, Homedialysis, HD
How longer HD treatments affect bone minerals
The ACTIVE study randomized 200 people to do 24+ hours of HD per week vs. standard (<18 hours per week) HD. Long HD treatments reduced serum phosphate levels, but did not change PTH or serum calcium. In a second analysis of the data, those who did longer HD needed fewer phosphate binders as well.
Read the abstract » | (added 2019-07-15)
Tags: HD Duration, Long Hd Treatment, Serum Phospate, Mineral Metabolism, Phosphate Binders
Bone Mineral Balance in Short Daily HD: A Cautionary Tale
A new case report suggests that bone mineral balance may need extra attention for those doing short daily HD. A patient who had multiple fractures and bone pain severe enough to require a wheelchair for more than a year was found on biopsy to have osteomalacia, likely due to chronically low levels of serum phosphorus and calcium. Increasing these minerals in the dialysate enabled the patient to leave the wheelchair and walk pain-free.
Read the abstract » | (added 2017-09-15)