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)

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Are we finally nearing the end of Kt/V?

We have been vocal critics of Kt/V on Home Dialysis Central since the start—and now we are not alone. A new paper finds that Kt/V is not a good fit for short daily or long nocturnal treatments, to the point where, “urea kinetics are hardly if at all representative for those of other solutes with a deleterious effect on morbidity and mortality of uremic patients.”

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

Tags: Nocturnal Hemodialysis

Metanalysis of low-glucose PD fluid and residual kidney function

An analysis of six randomized controlled trials of neutral pH, low-glucose PD fluids has found that patients who used these fluids had a much slower rate of residual kidney function loss and much higher weekly Kt/Vs than those using standard PD fluids. There were no significant differences between groups in ultrafiltration, blood pressure, or all-cause mortality.

Read the abstract » | (added 2015-04-10)

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On PD, less inflammation linked with longer survival

Among 87 people on PD, ages 30-85, who were followed for 30 months, the inflammation marker serum amyloid-A (SAA) was a significant independent predictor of mortality. When four markers of inflammation were analyzed together, SAA, age, and the presence of cerebrovascular insults were the strongest predictors.

Read the abstract » | (added 2015-03-11)

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Is low blood sodium as harmful in PD as it is in HD?

Hyponatremia (low blood sodium levels) raise the risk of death in people who do standard in-center HD. A prospective observational study of 441 incident PD patients found a higher mortality risk among those who did PD, too. In fact, after 3 years, the 1/3 of study participants whose sodium was lowest had a 79% higher risk of death than those whose levels were higher.

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

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First-year outcomes of incident US PD patients

Among 1,677 incident PD patients from Fresenius, 367 switched to HD within the first 90 days. Of those who continued with PD, first-year mortality was 10 per 100 patient-years, with 42 episodes of peritonitis and 128 hospitalizations per 100 patient-years. About 2/3 of the hospitalizations occurred in the first 6 months of PD therapy. Of those who switched to HD, 81.4% began treatment with a central venous catheter—and 78.3% still had one 90 days later.

Read the abstract » | (added 2014-07-07)

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Home HD survival in New Zealand

Researchers analyzed 15 years worth of home HD data in NZ (6,419 patients and 20,042 patient-years of follow up). After adjusting for comorbidities, home HD had 52% better survival than in-center HD. PD had 20% better survival than in-center HD in the first 3 years—but a 33% higher mortality risk after that.

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

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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