Journal Watch - 2013

« Back to Most Recent

  1. Home HD: A good start's the key

    A look at 95 home HD patients found that those who started treatment in the hospital or with a catheter had far higher rates of hospital stays, changing to another treatment, or death than those who had better starts. For both new patients and those coming to dialysis from a failed transplant, a planned home HD start with a permanent access led to better outcomes.

    Read the abstract » | (added 12/10/2013)

    Tags:

  2. Ultrathin silicon membranes for wearable dialysis.

    A wearable artificial kidney will need a membrane efficient enough to remove a lot of toxins in a small device. This article explains the technical details of porous nanocrystalline silicon made into chips. Pore size can be controlled to keep albumin in but let middle molecules out, like a healthy kidney. Special coatings that repel water keep proteins from adhering to the membrane.

    Read the abstract » | (added 12/10/2013)

    Tags: Chronic Kidney Disease

  3. PD fluid: Does less sugar lead to better outcomes?

    A recent randomized, controlled trial with 251 patients combined two studies of standard vs. low-glucose PD fluids. The study looked at hemoglobin A1c levels. In the low-glucose fluid group, A1c and triglyceride levels dropped and lipid profiles improved. But...there were more serious events and deaths in this group due to fluid overload. So, the low-glucose fluid was better for blood sugar and lipids, but with a higher risk of fluid problems. The authors suggest that if low-glucose fluids (like icodextrin) are used, it is vital to watch fluid levels closely.

    Read the abstract » | (added 12/10/2013)

    Tags:

  4. Urgent-start PD: A how-to guide

    Many nephrologists would choose PD for themselves. But few patients start on it, in part because ESRD may be found so late that dialysis is imminent. If only PD starts could be as done as easily as HD catheter placements... As it turns out, PD can be started on an urgent basis, and this approach is starting to pick up speed. This article reviews the literature, ways to overcome challenges, and the possible impact of changing the paradigm away from a default of standard in-center HD.

    Read the abstract » | (added 12/10/2013)

    Tags:

  5. Stacking up intensive HD against standard in-center HD

    We know that the risk of death is far higher for patients after two days with no HD. Do longer and/or more frequent HD regimens successfully address this problem and save lives? This review compares the impact of different HD regimens on a number of factors, including access problems, burden of therapy, quality of life, residual kidney function, heart disease, bone disease, anemia, hospitalization, and survival.

    Read the abstract » | (added 11/06/2013)

    Tags:

  6. The Brits are doing something right in home HD

    Among 166 home HD patients in Manchester, UK (chosen with "liberal selection criteria"), the drop-out rate was far smaller than we tend to see in the US. In 8 years, just 24 patients switched to a different option. Technique survival at home was 98.4% at 1 year, 95.4% at 2 years, and 88.9% at 5 years, excluding death and transplant. Patients older than 60, those with diabetes or heart failure, and those with more comorbidities were more likely to stop doing home HD. The technical error rate was just 0.7% per year.

    Read the abstract » | (added 11/06/2013)

    Tags:

  7. One type of PD catheter offers a significant survival advantage

    Coiled? Swan neck? Straight? As it turns out, the catheter shape does matter. A new metaanalysis of 13 randomized controlled trials found that both catheters and people were twice as likely to survive when catheters were straight—not coiled.

    Read the abstract » | (added 11/06/2013)

    Tags:

  8. PD First. It makes sense!

    Why is the default US dialysis standard in-center HD, when it doesn't offer the best outcomes, costs more, and offers a poor quality of life? That's the question asked in a new review article that points out the benefits of a PD first strategy. Rather than allowing ease of HD initiation to drive treatment "choice," it makes sense to change the default initiation option to PD.

    Read the abstract » | (added 11/06/2013)

    Tags:

  9. Is there a new way to prevent PD infections? Sorry, honey

    Honey has a long history of helping to heal wounds—with no risk of antibiotic resistance. But, a recent trial of the sweet stuff in PD exit site infections did not show a benefit. Researchers asked 186 patients from 26 clinics in Australia and New Zealand to put purified honey on their exit sites, while a control group (185 people) used standard care (or mupirocin if they carried S aureus). The time to first infection was about the same in both groups.

    Read the abstract » | (added 11/06/2013)

    Tags:

  10. What are the challenges for successful home HD?

    The UK has actually set a goal in 2002 for home HD of 10-15% of dialysis patients, but has not reached it yet. A new study (BASIC-HHD) is starting to look at the reasons for underuse of a treatment option that offers better results than standard in-center HD. A total of 500 patients will be followed, 200 pre-dialysis, 200 hospital HD, and 100 home HD from across the UK. The predialsyis patients will be followed for a year to better understand their journey to ESRD and renal replacement. They will be interviewed, take psychosocial assessments, and have blood tests. The researchers will also look at the attitudes and practices in dialysis clinics, the economics of home treatment, and care partner concerns.

    Read the abstract » | (added 10/02/2013)

    Tags: