Results of a Metaanalysis of Nocturnal vs. Standard HD

Researchers who looked at 28 studies of 22,508 patients found a mixed bag: comparable side effects and mortality between nocturnal and standard HD, less hospitalization with standard HD—but better heart health and physical quality of life with nocturnal HD, with fewer blood pressure medicines needed.

Read the abstract » | (added 2017-03-09)

Tags: Hemodialysis

Time Matters: HD Kt Dose , Hospitalization, and Death

Does adding more HD benefit patients? Yes, finds a Fresenius study of 6,129 patients in Spain. There as a progressive increase in the risk of death for patients who were below the target Kt, and as Kt rose to reach and exceed the target, the risk declined, as did the risk of hospitalization. “Thus, prescribing an additional 3 L or more above the minimum Kt dose could potentially reduce mortality risk, and 9 L or more reduce hospitalization risk,” noted the authors.

Read the abstract » | (added 2016-11-10)

Tags: Hemodialysis

The HEMO Study Returns with a New Message

“An index only on the basis of urea does not provide a sufficient measure of dialysis adequacy,” finds yet another reanalysis of the by-now-ancient HEMO study data. Looking only at small uremic solutes—even non-urea wastes—did not predict all-cause mortality. Doing HD just three times a week made it impossible to remove enough solutes to matter.

Read the abstract » | (added 2016-11-10)

Tags: Hemodialysis

Overhydration and Mortality Risk on PD

When PD does not remove enough water, the resulting overhydration is a major risk factor for death. A study of 54 PD patients between 2008 and 2015 measured with bioimpedance technology were divided into normohydrated and overhydrated groups. Older age, low diastolic blood pressure and overhydration predicted mortality.

Read the abstract » | (added 2016-08-09)

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

Survival on PD is Better with Normal Magnesium Levels

A retrospective study of 253 incident PD patients followed for up to 10 years found that deaths due to cardiovascular causes (58.3%) were linked with low serum magnesium levels. Low serum albumin, and levels of triglycerides, potassium, calcium, and phosphate were also important. Those in the group with the lowest magnesium had significantly higher all-cause mortality (p<0.001).

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

Tags:

Why Do People Stop Doing Home HD?

Among 2,840 people who started home HD between 2007 and 2009, nearly one in four stopped within a year, while 1-year mortality was 7.6%. The risks of stopping home HD were higher among those with diabetes, and substance use (alcohol, tobacco, drugs). Those who were listed for transplant or lived in rural areas were less likely to stop home HD.

Read the abstract » | (added 2016-01-10)

Tags: Hemodialysis

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)

Tags:

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)

Tags: