Home FIRST—a new paradigm

Why is the least effective—and most costly—form of treatment the default choice in the U.S.? A new article asks this question, and suggests that we present treatment options in terms of home vs. in-center, rather than HD vs. PD.

Read the abstract » | (added 2011-02-24)

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Wearable artificial kidney...for PD?

Dr. Claudio Ronco reports in a new article that many of the challenges of making a wearable artificial kidney could be solved if it was used for PD instead of HD.

Read the abstract » | (added 2011-02-24)

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A honey of an idea

Some clinics help prevent peritonitis in people with PD by using an antibiotic ointment. But bacteria may become resistant. In Australia, a new randomized study of Medihoney, a honey-based wound dressing (which is FDA-approved in the US) will see whether exit site or tunnel infections or peritonitis can be reduced.

Read the abstract » | (added 2011-02-24)

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Better stats help prove the value of more dialysis

It's clear to us that more dialysis is more like having healthy kidneys. But the statistic used to measure the risk of death ("proportional hazards model")...didn't quite succeed. A new statistical model based on when the kidneys fail and toxins start to build up DOES find a strong relationship. In fact, each 0.1 unit increase in Kt/V improved survival by 3.5%!

Read the abstract » | (added 2011-02-24)

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Diabetes + PD? Icodextrin-aided fluid removal and metabolic control

A randomized controlled trial of glucose PD fluid vs. icodextrin (ICO) found significant benefits. Among 59 people with diabetes on CAPD, those in the group using ICO for the long exchange were far less likely to need higher concentration fluid (9% vs. 66%). And, the ICO group needed less insulin, had lower triglycerides, and had lower A1cs.

Read the abstract » | (added 2011-02-24)

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Rat study: Celexicob reduces peritoneal fibrosis

COX-2 is involved in fibrosis and the growth of new blood vessels. Is there a way to protect the peritoneal membrane using a COX-2 inhibitor so it lasts longer for PD? Perhaps one day there will be. A new study found that rats given a substance that causes fibrosis had fewer new blood vessels and milky spots, and far less fibrosis than controls.

Read the abstract » | (added 2011-02-24)

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Mupirocin (Bactroban®) reduces staph exit site infection and peritonitis in PD

A meta-analysis of 14 studies looking at 1233 patients and 1217 controls has concluded that using an ointment with mupiricin can help prevent PD problems. Exit site infections and peritonitis—both due to staph aureus and to some other germs—were reduced by as much as 72%.

Read the abstract » | (added 2011-02-24)

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PD catheter placement: Surgeon or nephrologist?

Does who places a PD catheter make a difference in complications or catheter survival? Not really, finds a new Greek study that looked at 152 patients who received 170 catheters. Only early leakage (easily treated) was more likely with nephrologist placement.

Read the abstract » | (added 2011-02-24)

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Icodextrin PD fluid causes less weight gain

We're not surprised to learn that PD fluid that doesn't contain dextrose (sugar) is less likely to cause weight gain! A study of 183 PD patients found weight gains after 3 years (88% of it fat) among those using standard fluid, and significantly less weight gain in an icodextrin group.

Read the abstract » | (added 2011-02-24)

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Which is safer for placing a PD catheter: General or local anesthesia?

Trick question. Turns out, they're both safe! In more than 300 people followed between 1999 and 2008, there were no major complications in either group. PD catheter failure rates were similar (5% for general, 7% for local).

Read the abstract » | (added 2011-02-24)

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