A Patient on Home HD for 45 Years

A 62-year old Mississippi woman, one of the first home HD patients of Dr. John D. Bower, is reported to have been on home HD for 45 years now, a record.

Read the abstract » | (added 2019-09-11)

Tags: Home Hemodialysis, Quality Of Life, Long term Survival

RCT: Which Works Best, Straight or Coiled PD Catheters?

A metaanalysis recently found that straight catheters were better, and an RCT of 308 CAPD patients randomly assigned to receive a straight (n=153) or coiled (n=155) catheter corroborates that finding. After a mean follow-up of 21 months, straight PD catheters caused almost 9 times less dysfunction or drainage failure (0.7% vs. 5.8%) with less pain than coiled catheters. Both catheters had a similar risk of peritonitis.

Read the abstract » | (added 2019-09-11)

Tags: Catheter, Randomized Controlled Trial (RCT), PD, CAPD

Glycated Albumin vs. HbA1c Predicts Mortality in PD Patients with Diabetes

In patients on hemodialysis, glycated albumin (GA) reflects glycemic control and predicts all-cause mortality. A new retrospective, longitudinal observational study looked at GA in PD. Among 44 PD patients with diabetes matched to 88 HD patients with diabetes followed for 3 years, GA was a more precise way to measure glycemic control than hemoglobin A1c.

Read the abstract » | (added 2019-09-11)

Tags: Peritoneal Dialysis, All cause Mortality, Glycaemic Control, Glycated Albumin, Glycated Haemoglobin

Some PD PETs Are Better Than Others

There are three ways to do a peritoneal equilibrium test (PET) to measure how well someone’s peritoneum is able to transport water and wastes. Compared to a traditional PET, a modified PET had good agreement in 21 patients—but the so-called mini-PET did not.

Read the abstract » | (added 2019-08-14)

Tags: Peritoneal Equilibrium Test, PET, Peritoneal Membrane Transport

Payment Policy is Driving Increases in U.S. Home Dialysis

Follow the money. Analysis of 523,526 patients starting dialysis in the U.S. between 2005 and 2013 found increases in home dialysis use in all groups, and a decline in racial/ethnic differences in home dialysis. However, over time, white patients had an increase in mortality compared to minority patients, while transplant rates remained lower in minority patients.

Read the abstract » | (added 2019-08-14)

Tags: Home Dialysis Outcomes, Racial, Ethnic, Mortality, Transplant Rates

Challenges in Assessing Survival of In-center vs. Home HD

It’s treatment time that matters, not location—of course—suggests a new thorough review of the survival data. And, while it is challenging to prove a survival benefit when all home HD is so often conflated (short daily vs. nocturnal, for example), quality of life is demonstrably better—and matters more to patients.

Read the abstract » | (added 2019-08-14)

Tags: Treatment Time, Survival Data, Modality, Quality Of Life

Fluid Management Risks of Incremental HD

Incremental HD critics worry that less-frequent treatments will lead to fluid overload—and they may be right. A sample of 23 patients had interdialytic weight gains (IDWG) analyzed in the first and last 3 months of twice-weekly (2x) HD and first 3 months of thrice-weekly (3x) HD. IDWG exceeded 5.7% of dry weight 0% in the first 3 months of 2x HD—12% in the last 3 months—and 4% after a switch to 3x. The authors said, “fluid management in incident-ESKD patients receiving bi-weekly HD deteriorates prior to conversion to thrice-weekly HD.”

Read the abstract » | (added 2019-08-14)

Tags: Incremental HD, Fluid Management Risks, Volume Management

High Fiber Diet May Save Lives on PD

A study of 881 PD patients followed for up to 12 years found that participants who ate more fiber tended to be younger, male, and have more residual kidney function. In those who did not have diabetes, each 1 gram increase in daily fiber intake independently predicted improved survival by 13%.

Read the abstract » | (added 2019-08-14)

Tags: Chronic Kidney Disease, Dietary Fiber, Mortality, Peritoneal Dialysis

PD: Better Quality of Life than In-Center HD for 2 Years

Among 989 patients starting PD or in-center HD, health-related quality of life (HRQOL) was measured at 3, 12, and 24 months after dialysis start. PD patients scored higher all along on several key dimensions than HD patients—and this effect lasted up to 2 years. Both PD and HD patients had about the same amount of decline in HRQOL over 2 years.

Read the abstract » | (added 2019-08-14)

Tags: HRQOL, PD, In center HD, Quality Of Life

Remote PD Monitoring Reduced Hospitalizations

A study of people starting automated PD matched patients who did and did not receive remote patient monitoring (RPM), with 63 patients in each group. Those who received RPM had significantly fewer hospital stays and days.

Read the abstract » | (added 2019-08-14)

Tags: Automated PD, Remote Patient Monitoring, Hospitalization