Journal Watch - 2015

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  1. Meta-Analysis: Longer Dialysis, Better Pregnancy Outcomes

    A new metaanlysis analyzed 190 papers and 25 abstracts covering 681 pregnancies in 647 women on dialysis. Meta-regression analysis found that more hours of HD per week was associated with a lower rate of preterm delivery, and that more dialysis sessions per week was associated with larger birthweight babies. Case reports suggested fewer small for gestational age babies with HD than with PD. No increased risk of birth defects was found.

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  2. Home HD Has Shorter Recovery Time After Treatment Than In-Center HD

    A UK study asked 288 people “how long does it take for you to recover from an HD session?” Compared to a mean of 193 minutes (3+ hours) for the 197 people dialyzing in-center, the 91 home dialyzors had a mean of 67.3 minutes (just over an hour). While conventional home HD vs. intensive home HD had similar results, those who made more urine recovered faster.

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  3. Buttonhole Cannulation Does NOT Raise Infection Risk—at Satellite

    AVF infection rates were examined among 162 patients from 1990 through 2012, which represents a changeover from rope ladder cannulation (1990-1998) to the Buttonhole technique (1998 onward). The difference in infection rates between the two techniques was not significant. Recurrence of AVF-infection was found only during time 2.

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  4. Liraglutide Has Multiple Benefits in People with Diabetes on PD

    In a small study, injectable liraglutide was tested in 16 people with type 2 diabetes who use PD, 11 of whom were previously on insulin, while three used oral medications and two controlled their blood sugar using diet alone. After 12 months, glucose fluctuations were reduced, post-meal blood sugars were lower, systolic blood pressure dropped—and left ventricular mass decreased (on echocardiogram).

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  5. Gentamycin Ointment For PD Exit Sites Did Not Increase Antibiotic Resistance

    A review compared 10 years PD exit-site care using oral rifampin and mupirocin ointment (n=265) with 10 years of gentamycin cream (n=179). While the demographics were largely similar apart from race, there were significantly fewer gram-negative exit site infections using gentamycin, with very low rates of gentamycin resistant infections in either period.

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  6. RCT of Self-Locating PD Catheter Finds Fewer Flow Problems

    Coiled or straight, Tenckhoff catheters often clog. A new small trial randomized 61 people to receive a straight Tenckhoff (n=32) or a new, self-locating Wolfram PD catheter (n=29) for urgent start PD. Seven of the Tenckhoff’s had to be swapped for Wolframs due to flow issues—but the reverse was not true.

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  7. Trial of a Virtual Home HD Ward

    Transitions from hospital stays back to home can lead to gaps in care. In Toronto, a virtual ward (VW) has been tested to see if care can be made more seamless. Following hospital discharge, a procedure, an antibiotic prescription, and/or completion of home dialysis training, patients were followed in the VW for 14 days. A nurse looked for the need for an HD prescription change, coordination of follow-up care, and medication changes. Care gaps were found in 67% of the 52 VW admissions for a total of 85 gaps. The researchers concluded that using a VW is practical, feasible, and identifies gaps that can be addressed.

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  8. Case Report: Thrombocytopenia with NxStage

    Two patients have developed thrombocytopenia while using NxStage dialysis machines, perhaps due to electron-beam sterilization of the dialyzers. Switching to another machine resolved the problem; but it recurred in the patient who retried NxStage.

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  9. UK Identifies Ways to Boost Use of Home HD

    Commissioners in the West Midlands, where home dialysis rates had been falling for 10 years, set a target for home dialysis uptake. Comparing this area’s seven hospitals with the rest of England for 3 years before and after the target found significant increases at the study hospitals. Use of financial penalities, adding funding for specialist staff and equipment, having visible champions, good systems for patient training, and ongoing healthcare support at home all helped. Lack of training for non-specialists, poorly developed patient education, and patients’ unmet emotional needs are ongoing challenges.

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  10. Vascular Access Technique Audits Can Reduce Home HD Access Infections

    Self-cannulation errors can lead to infections. A retrospective study of all prevalent home HD patients at the University Health Network in Canada looked at access infections between 2006 and 2013. Among the 92 patients who completed at least one vascular access audit, those with five or more errors had significantly higher infection rates. Longer duration on home HD was associated with higher error rates. Audits give nurses a chance to retrain patients and reduce future errors and infections.

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