Journal Watch
An Integrated Home Approach: PD to Home HD
Even in Canada, it is rare (2-6%) that patients who stop PD transfer to home HD. A new review article shares data and describes an integrated home dialysis model that covers patient identification, timely transition planning, and challenges.
Read the abstract » | (added 2024-11-21)
Tags: PD Transfer To Home HD, Transition, Integrated Home Dialysis Model
Staying Infection-free with PD and Home HD
While home treatments tend to be better treatments, infection is still a risk—and prevention a necessity. Education and inclusion of infection-prevention in training are important, as are managing modifiable risk factors, such as constipation, gastric acid blockers, and hypokalemia in PD. For home HD, reducing CVC use and duration and using the rope ladder technique for cannulation can reduce risk.
Read the abstract » | (added 2024-11-21)
Tags: Infection prevention, Modifiable Risk Factors, PD, HHD, Central Venous Catheters, CVC
Stepwise PD Starts vs. Conventional PD Starts—Which is Better?
Stepwise Initiation of PD (SIPD) is an approach that uses a gradual introduction to PD (perhaps like incremental PD in the U.S.?). In a retrospective look at 39 SIPD patients vs. 78 conventional PD (CPD) starts during a 13-year period matched for age and sex, early complications and PD catheter survival were similar between groups. But, late complications were significantly lower in the SIPD group. The authors believe SIPD may aid tissue healing and reduce biofilms, which may reduce infections. As always, more studies are needed…
Read the abstract » | (added 2024-11-21)
Tags: Stepwise Initiation Of PD, Incremental PD, Late Complications, Infection, Tissue Healing, Biofilms
Pet Cats and Peritonitis—a Non-starter for PD?
The answer might surprise you. In a retrospective registry study in France, 52 PD patients who developed cat-related peritonitis were matched with 208 controls whose PD peritonitis was due to other causes. After analysis, pet-related peritonitis had lower risks of death or transfer to HD and a higher rate of transplant than other-cause peritonitis. The authors concluded that, while cats may cause peritonitis, having pets at home should not be considered a reason to refuse patients PD.
Read the abstract » | (added 2024-11-21)
Tags: Pets, Cats, Peritonitis, Pet related Peritonitis, PD, Technique Survival
Unphysiology is Back and Affects the Heart in Standard HD
It’s been quite a while since “unphysiology” appeared in a journal article title. The authors note that the intermittent nature of in-center HD causes significant upward and downward fluctuations that affect fluid status, add to hemodynamic instability, and increase cardiovascular risk. More frequent HD modalities, on the other hand, can reduce left ventricular hypertrophy, improve BP control, and possibly boost survival, and PD is more continuous and gentle.
Read the abstract » | (added 2024-11-21)
Tags: Unphysiology, In center HD, Fluid Status, Hemodynamic Instability, Cardiovascular Risk, HD, PD
Updated ISPD Adequacy and Prescription Clinical Guidelines
PD adequacy is transitioning from solute clearance and ultrafiltration to quality of life. With sections on adequacy, residual kidney function, and prescription of CAPD and APD, the new guidelines specify the level of evidence and strength of the recommendations
Read the abstract » | (added 2024-10-15)
Tags: PD Adequacy, Solute Clearance, Ultrafiltration, Quality Of Life
More Nephrologist Time Linked with Lower PD Peritonitis and Catheter Infection Rates
A PDOPPS study in Korea divided 276 incident PD patients into two groups based on whether they got <15 minutes (n=184;66.7%) vs. >15 (n=92; 33.3%) minutes of nephrologist time during each visit. Average age between groups did not differ, but the group that had more nephrologist time had significantly fewer 3- and 12-month PD-related infections.
Read the abstract » | (added 2024-10-15)
Preferences for ESKD Treatment Options among Seniors
A choice experiment of 327 UK seniors (median age 77) with stage 4 CKD examined the survival benefit patients needed 2 years after starting treatment to accept dialysis. Overall, they needed 8-59% absolute survival benefit, and preferred less frequent treatment and home treatment. Seniors who had partners had significantly higher preferences for survival. Most wanted their capacity preserved and an acceptable frequency of care.
Read the abstract » | (added 2024-10-15)
CAPD vs. APD: Meta-analysis Sheds No New Light
A Cochrane Kidney and Transplant Register of Studies update identified two new randomized controlled trials (n=131) to include, one with 6-month follow-up and one with 24-month follow-up. Both studies had mostly low risk of bias. Conclusions about differences in CAPD and APD outcomes for death, hospitalizations, peritonitis, modality change, residual kidney function, health-related quality of life, overhydration, blood pressure, and a host of other outcomes were all based on low to very low certainty evidence.
Read the abstract » | (added 2024-10-15)
Tags: CAPD, APD, Modality Outcomes
Cloudy-only Peritonitis May Point to Vancomycin First
A study that looked at clinical characteristics of PD-associated peritonitis (PDAP) was able to correlate the signs and symptoms with the pathogen, allowing the team to choose antibiotics in a more informed way. The researchers divided the records of 162 patients with culture-positive PDAP into those who had cloudy effluent only vs. those who also had pain and/or fever, and compared the culture and sensitivity results. All 30 of the cloudy-only group had gram-positive infections; significantly more than the multi group (P<0.001), and 29 of those infections were susceptible to vancomycin, for specificity of 98.48%. This insight may help guide a first choice of antibiotic.
Read the abstract » | (added 2024-10-15)
Tags: PD associated Peritonitis, Cloudy Effluent, Vancomycin