Home HD Core Curriculum 2021

AJKD has released a new edition of this manual, which covers benefits, pitfalls and challenges of starting and growing a home HD program, home HD equipment, prescriptions, and medical management.

Read the abstract » | (added 2021-12-16)

Tags: Home Hemodialysis, HHD, Home HD Program, Patient Choice

Oral Hygiene and Nutritional Status on PD

Clean teeth mattered for nutritional status and hand grip strength in a small study (n=41) of people on PD. Inflamed gums can cause tooth loss and limit what people can eat. Those with dirty to very dirty teeth had poorer nutrition than those with clean or slightly dirty teeth, and their hand grips were weaker. Those with dirty teeth also had more GI symptoms and a higher risk of malnutrition.

Read the abstract » | (added 2021-12-16)

Tags: PD, Tooth Loss, Malnutrition, Gingivitis, Periodontitis

Standard vs. Incremental PD Start: 12-year Retrospective Study

When people start PD with some residual function, is it beneficial not to begin with a full PD prescription? A study looked back at 12 years of people who started PD, 232 standard and 71 intermittent (iPD; 2-3 manual exchanges per day). Those who did iPD had higher residual kidney function than those on standard PD. For people with diabetes, iPD was linked with a survival advantage as well.

Read the abstract » | (added 2021-12-16)

Tags: PD, Residual Function, Intermittent PD, IPD, Diabetes

Clinically-focused Shared Decision-making Does NOT Improve Home Dialysis Uptake

A qualitative interview study with 95 people in Wales found that generic, clinically-focused shared decision-making was not able to overcome denial, lack of symptoms, and health systems issues to increase use of home dialysis. Unmet and unrecognized family needs and untranslated medical knowledge were additional challenges. The “simplest” option seemed to be standard hemodialysis.

Read the abstract » | (added 2021-12-16)

Tags: Clinically focused Shared Decision making, Home Dialysis Uptake, Pre dialysis

Simplified Half Percutaneous PD Catheter Placement Technique

Use of a simple modified metal trocar was safe and effective in a series of 280 consecutive PD patients followed for 3 years. Taking an average of less than 30 minutes, the new technique was technically successful 99.3% of the time initially, with mechanical complications occurring in 10% during the follow-up period; most commonly catheter malfunction, and 32 episodes of peritonitis (10.4%). By the end of the study, 83.9% lived and still had their initial catheters.

Read the abstract » | (added 2021-12-16)

Tags: PD, Peritoneal Dialysis, Catheter, Half percutaneous Technique

Platelet-to-Albumin Ratio Predicts PD Technique Success and Survival

Dividing patients’ absolute platelet counts by their serum albumin levels creates a protein-to-albumin ratio (PAR) that predicts PD outcomes, finds a new study of 405 people over a median of 2 years. Patients with lower PAR levels had higher rates of PD success and better survival.

Read the abstract » | (added 2021-12-16)

Tags: Platelet to albumin Ratio, Technique Failure, Mortality, Peritoneal Dialysis

Health-related Quality of Life Better on PD than Standard HD in Morocco City

Compared to 71 people using standard HD, 20 doing PD had significantly better physical and mental component scores and staff encouragement, and significantly lower burden of kidney disease scores.

Read the abstract » | (added 2021-11-12)

Tags: Standard HD, PD, Component Scores, Burden Of Kidney Disease Scores

Some Antihypertensive Meds Reduce GI Bleeds in PD

GI bleeding is more likely in people with CKD. A study of 734 people on PD were followed to see if use of an ACE-inhitor or angiotensin receptor blocker (ARB) would reduce the incidence. After an 8-year follow-up, those who were taking these meds had a significantly lower rate of GI bleeding.

Read the abstract » | (added 2021-11-12)

Tags: GI Bleeding, CKD, PD, ACE inhitor, Angiotensin Receptor Blocker

Italians Improve on Daily Home HD

As in the U.S., the Italian Ministry of Health has home dialysis as a primary objective. In a 2-year study of seven people switched to six times per week daily home HD, significant improvements began to appear almost immediately. After 3-6 months, bone mineral balance and blood pressure were better, PTH levels and use of phosphate binders dropped, and the participants needed less rhEPO.

Read the abstract » | (added 2021-11-12)

Tags: Home Dialysis, Daily Home HD, RhEPO, Mineral Balance, Blood Pressure, PTH Levels

New Clinical Practice Guidelines for Exercise on PD

The International Society for Peritoneal Dialysis and the Global Renal Exercise Network have teamed up to grade and review the literature and clinical experience to help people on PD stay physically active safely. With sparse quality evidence available, the new guidelines are largely opinion based, and cover timing of exercise relative to PD (i.e., empty or full); impact of exercise on mental health, weight, frailty, etc.; exercise nutrition, and potential adverse PD outcomes.

Read the abstract » | (added 2021-11-12)

Tags: Peritoneal Dialysis, Exercise, Physical Activity, PD Outcomes