Journal Watch
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Racial and Ethnic Disparities in Access to Home-Based Renal Replacement Therapies Among Incident End-Stage Renal Disease Patients in the United States
This retrospective study of 3.49 million patients in the USRDS database who started dialysis between 2014 and 2020 found that compared to White patients, Black and Hispanic/Latino patients were less likely to start dialysis on a home modality. Asian patients had somewhat higher rate of starting PD. The conclusion stated: “Substantial racial and ethnic disparities persist in the initiation of home dialysis in the U.S. While structural and system-level factors likely contribute, patient-level clinical considerations, cultural norms, social support availability, and provider practice patterns also play important roles.”
Read the abstract » | (added 2026-10-22)
Tags: Racial And Ethnic Disparities, Home Based Renal Replacement Therapies
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Peritoneal Dialysis Catheter Flushing in Children: A National Survey of Practice Patterns
Researchers surveyed 60 U.S. pediatric PD programs for PD catheter flush protocols between placement and starting PD treatment. Of the 43 respondents, 83% had a protocol. However, variation in their protocols led the researchers to recommend multi-center studies to establish a standardized catheter flushing protocol based on evidence-based guidelines.
Read the abstract » | (added 2026-09-18)
Tags: Pediatric PD, PD Catheter Flush Protocols, Standardized Catheter Flushing Protocol
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VHA Nationwide Survey of PD Infrastructure and Clinical Practice
Increasing use of PD for Veterans is a strategic priority for the Veteran Healthcare Administration (VHA). A nationwide stakeholder survey was conducted to improve Veterans ability to choose, access, and receive excellent quality PD. A total of 27 programs responded; differences were found in PD infrastructure and clinical practices. Larger PD programs offered more services than small ones. Aligning infrastructure, standardizing best clinical practices, and quality improvement efforts are starting to increase successful PD use.
Read the abstract » | (added 2026-06-17)
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Home Dialysis in Finland
Prevalence of home dialysis has dropped in the past decade in Finland, despite its better survival compared to in-center HD. Semi-structured surveys for nephrologists, nephrology nurses, and patient associations endeavored to understand why. Nursing shortages and patient comorbidities received wide agreement as barriers, and clinicians believed that starting in-center reduces the odds of switching to home treatments later. For patients, financial burdens and impact on care partners were critical, as was “bringing hospitals home” or living in small spaces.
Read the abstract » | (added 2025-03-13)
Tags: Home Dialysis, Survival, Modality, Barriers
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Preferences for ESKD Treatment Options among Seniors
A choice experiment of 327 UK seniors (median age 77) with stage 4 CKD examined the survival benefit patients needed 2 years after starting treatment to accept dialysis. Overall, they needed 8-59% absolute survival benefit, and preferred less frequent treatment and home treatment. Seniors who had partners had significantly higher preferences for survival. Most wanted their capacity preserved and an acceptable frequency of care.
Read the abstract » | (added 2024-10-15)
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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
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Incremental PD and Patient Outcomes: Registry Data
Between 2007 and 2017, incremental PD use increased by 2.7% in the ANZDATA database. Most (67%) used the approach for one year or less. After controlling for patient and center variables, starting PD with incremental treatments reduced peritonitis risk and transfers to in-center HD, with no increase in mortality.
Read the abstract » | (added 2023-09-13)
Tags: Incremental PD, Incremental Treatments, Peritonitis, Mortality Rate
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Incremental PD and Quality of Life
In a 4-year study (2015-2019) of adults starting PD and followed for one year, those who used incremental PD had better KDQOL physical composite, burden of kidney disease, and effects of kidney disease scores, as well as less hospitalization and lower mortality rates (non-significant).
Read the abstract » | (added 2023-09-13)
Tags: Incremental PD, KDQOL, Mortality Rate, Quality Of Life
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U.S Nephrologists on When to Start Dialysis
While clinical practice guidelines recommend starting dialysis mainly on signs and symptoms, almost half of 255 nephrologists surveyed relied solely on eGFR. For them, a level of 8.4 meant dialysis—even in the absence of symptoms.
Read the abstract » | (added 2022-12-19)
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The Predictive Value of Early, Non-infectious PD Complications
A prospective, multicenter cohort study of 1,596 people starting PD in New Zealand from 2014 to 2018 (inclusive) looked at survival and time on PD of those who had catheter-related exit site dialysate leaks or other leaks within 30 days of PD start. Peritonitis-free survival, first PD catheter survival, and tunnel infection free survival were secondary outcomes. Among the 102 with an early complication, overall mortality, the rate of stopping PD, and first catheter failure were all higher.
Read the abstract » | (added 2022-11-16)
Tags: PD, Survival, Peritonitis free Survival, First PD Catheter Survival, Tunnel Infection Free Survival, Early Catheter related Complication