Lessons from Europe: How to Grow PD

Analysis of 575 survey responses to a hypothetical case study of an unplanned dialysis start found that about 1/3 would recommend emergent start PD. About another 1/3 would start unplanned HD—and plan to educate about PD later. Predialysis education about PD, dedicated PD catheter placement teams, and other initiatives were most helpful.

Read the abstract » | (added 2021-09-14)

Tags: Peritoneal Dialysis, Emergent Start PD, Unplanned HD, PD Incidence, PD Prevalence

Bioimpedance-measured Fluid Overload and Short Daily HD Survival

In 297 patients switched from thrice-weekly to 5-6 sessions per week of in-center short daily HD (SDHD), predialysis hydration was measured at initiation of SDHD and 6 and 18 months later using bioimpedance. Compared to patients whose predialysis fluid overload (FO) was <15% of extracellular volume (ECV), those whose FO was >15% of ECV had no survival difference by 6 months. However, at 18 months, those with an FO <15% had 91% survival, while those whose FO was >15% had just 72% survival (p = 0.0006), and remained significant after adjustment for demographic, clinical, and laboratory variables.

Read the abstract » | (added 2020-05-12)

Tags: Bioimpedance; Dialysis; Fluid Overload, Hd, Demographic

Impact of daily low-flow HD on potassium and lactate levels

In the NxStage FREEDOM study, 345 patients switched from standard in-center HD to daily, low-flow HD. Blood levels of potassium and lactate were analyzed during the last 3 months of standard HD and the first 3 months of daily HD. On daily HD, predialysis serum potassium decreased significantly at a dialysate potassium level of 1 mEq/L, with no change at 2 mEq/L. Predialysis serum bicarbonate level decreased significantly with dialysate lactate concentration of 40 mEq/L—but increased significanty at 45 mEq/L. Choosing the correct dialysate for the patient is important.

Read the abstract » | (added 2019-07-15)

Tags: Daily HD, Potassium, Bicarbonate, Dialysate

5-year study: Predialysis PD Education Saves Lives on PD

Among 398 patients who started PD from 2007-2016, 169 had received predialysis education. After 5 years, this group had a significantly lower rate of peritonitis, a longer median time to a first peritonitis episode, and less risk of death from peritonitis than patients who did not get CKD education. Read the abstract.

Read the abstract » | (added 2018-09-10)

Tags: PD, Predialysis, Peritonitis, Mortality, CKD Education

The Secrets to Boosting Home Therapy Choice in Sweden

What factors make a choice PD or home HD more likely? A survey of Swedish patients found that receiving high quality, comprehensive predialysis information from three or more sources made a difference. Younger patients and men living with a spouse were also more likely to choose home, while those who lived close to a clinic were less likely. Once in-center, patients believed social interaction at the clinic influenced their choice.

Read the abstract » | (added 2018-08-13)

Tags: Dialysis Modality

Who Matters Most for Modality Choice: Clinicians or Patients?

New Zealand has one of the highest rates of home dialysis use in the world—and they still believe there is room for improvement. An online study of all NZ dialysis clinics coupled with a measure of “decisional power” aimed to see who had the most influence on modality choice. While respondents believed that predialysis nurses were most influential, nephrologists still held the most decisional power—and a one point increase in nephrologist decisional power drove a 6.1% rise in home dialysis use.

Read the abstract » | (added 2017-12-14)

Tags: New Zealand, Home Dialysis, Modality Choice, Patients

Patient Education Boosted Use of Home Therapies

In a 22-month period 108 people were enrolled in a comprehensive predialysis education program—and 70% chose a home treatment (55% PD; 15% home HD). Three sessions of education appeared optimal for helping patients reach a decision.

Read the abstract » | (added 2017-06-12)

Tags: Patient Education

VIPs in Dialysis Modality Choice

Whose opinion matters most to patients when it comes time to make a dialysis decision? In New Zealand, at least, it’s the nephrologist—even though respondents thought it would be predialysis nurses. In fact, a 1-point increase in nephrologist decisional power increased the rate of home therapies by 6.1%.

Read the abstract » | (added 2016-09-14)

Tags: Hemodialysis

Starting PD with Three Exchanges

Are four PD exchanges magical? Or could new patients thrive with three exchanges per day, at least for a while? In a new study, 46 incident PD patients began treatment with three exchanges. During the 2 years of the study, 25% received a kidney transplant. Most were able to use three exchanges for a mean of 24 months before needing a fourth, and there was less loss of residual kidney function than in the predialysis period prior.

Read the abstract » | (added 2016-05-12)

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Loss of Kidney Function Slowed After Starting PD

In 77 new PD patients, the rate of decline of kidney function was significantly slower after they started PD than it was when they were predialysis (p<0.01).

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

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