Journal Watch
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)
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
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
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
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)
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
Too-high OR Too-low LDL Cholesterol and Survival on PD
A retrospective study in China looked at data from 3,565 people starting PD from 2005 to 2020. Both higher and lower levels of LDL-C were linked with higher all-cause and cardiovascular mortality. Malnutrition and low LDL-C was especially risky.
Read the abstract » | (added 2022-08-11)
Tags: PD, LDL C, Cardiovascular Mortality, All cause Mortality, Malnutrition
Home Dialysis Associated with Higher Patient Activation
Increased patient activation is linked with better health outcomes. Among 182 people starting dialysis who took the Patient Activation Measure (PAM) survey at month 1 and month 4, those who did home dialysis tended to have higher PAM scores than those who did in-center treatments.
Read the abstract » | (added 2022-07-13)
Tags: Patient Activation, Health Outcomes, Dialysis, Patient Activation Measure, PAM, Home Dialysis
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
Meta-analysis of Risk Factors for Encapsulating Peritoneal Sclerosis
In data from 10 studies of 12,595 people, risk factors for EPS included younger age for starting PD, higher transport rates, longer PD duration, longer peritonitis duration, and history of glomerulonephritis.
Read the abstract » | (added 2022-04-18)
Tags: EPS, PD, Higher Transport Rates, Duration, Glomerulonephritis, EPS Risk Factors