Journal Watch
Which is Safer: Urgent Start HD or Urgent Start PD?
Analysis of data from 9 studies (941 PD and 779 HD patients) revealed that the risk of all-cause mortality, dialysis-related infections, and mechanical complications were higher in patients who started HD urgently than in those who started PD urgently.
Read the abstract » | (added 2024-07-12)
Tags: PD, HD, All cause Mortality, Dialysis related Infections, Mechanical Complications, Urgent start
A Validated Measure to Predict PD Technique Failure
Data from 424 adult PD patients were analyzed to construct a nomogram based on the best model (created with LASSO Cox regression). Model variables included hypertension, peritonitis, serum creatinine, LDL, triglycerides, fibrinogen, thrombin time, prothrombin activity, anemia, and serum albumin.
Read the abstract » | (added 2024-07-12)
Tags: Peritoneal Dialysis, Prediction Model, Technique Failure
Startling Proportion of Patients Chose PD or Home HD After a Dialysis Start Unit
The University Health Network of Toronto examined the uptake of home dialysis between 2013 and 2021 among patients who started in a “Dialysis Start Unit” (equivalent to a transitional care unit in the U.S.). Of 122 patients, 68 (55.7%) chose either PD (57; 46.7%) or home HD (11; 9%).
Read the abstract » | (added 2024-07-12)
Tags: Home Hemodialysis, HHD, Peritoneal Dialysis, PD, Dialysis Start Unit
A U.S. Staff-assisted PD Program
Staff-assisted PD has been successful outside the U.S., but is it feasible in the framework of U.S. healthcare? A pilot program with 16 clinics from August, 2020 to October 2023 suggests that it can. Some indications for referral of patients (73 of 112 referred) who received staff assistance were physical function limitations, cognitive impairments, and/or psychosocial challenges. The duration of assistance was limited, with a median duration of 8 days, primarily for treatment set-up, observation, and direction.
Read the abstract » | (added 2024-07-12)
Management of PD Anemia in Japan
Should people who use PD have the same hemoglobin (hb) targets as those who do HD? Researchers analyzed registry data of 4,875 patients 18 or older who were doing PD at the end of 2012 and compared their hb levels with mortality for the 1,586 who died. In a U-shaped curve, hb levels < 9.0 and > 13.0 were significantly associated with death. In those who had a history of cardiovascular disease, hb levels > 12.0 were significantly associated with death.
Read the abstract » | (added 2024-06-14)
An Integrated Care Model Supports Home Dialysis
A new paper describes a model of care that prioritizes safe and effective use of home therapies, patient-centered care, informed decision-making, and comprehensive support. The integrated care framework emphasizes continuous quality improvement and helps to identify and assess patients, educate them, facilitate transitions between modalities, and consider the logistics of urgent dialysis starts. The aim is to create a seamless transition to home.
Read the abstract » | (added 2024-06-14)
Tags: Model Of Care, Home Therapies, Patient centered Care, Informed Decision making, And Comprehensive Support, Integrated Care Framework, Modality
IM-HOME Study Examines Barriers to Home Dialysis
A small advisory board of patients, care partners, and providers devised lists of perceived barriers to inform an online survey. Respondents ranked their top three barriers and described barriers. Among 298 patients and care partners, the top three barriers were fear, lack of space, and a need for support. Provider- (n=224) perceived barriers were quite different: poor patient education; limited support for home staff, mental health, and education; and lack of experienced staff.
Read the abstract » | (added 2024-06-14)
Home HD, Self-cannulation, and Survival
An observational study of all home HD patients at a single center from 2001 to 2020 examined treatment survival and mortality. Among 77 self-cannulating patients dialyzing for a median of 18 hours per week, there were 11 deaths, largely cardiovascular, and 19 technique failures after 100 months, largely due to vascular access issues.
Read the abstract » | (added 2024-06-14)
Tags: Home HD, Self Cannulation, Treatment Survival, Mortality, Cardiovascular, Technique Failure, Vascular Access
Personalized PD Prescriptions
Urea alone is not able to assess dialysis adequacy. Rather than a focus on removing a single toxin, a more holistic, person-centered approach is emerging to improve well-being and minimize treatment burden—based on clinical outcomes and patient experiences of care. This approach requires close collaboration between patients and care teams and eliciting patient goals, priorities, and preferences. This paper reviews the evidence for a patient-centered approach to PD.
Read the abstract » | (added 2024-06-14)
Tags: Urea, Dialysis Adequacy, Treatment Burden, Patient centered Care, PD
Nursing Home Frequent Dialysis May Get People Home Sooner
Retrospective observation of admissions to skilled nursing facility (SNF) with on-site more frequent dialysis (MFD) studied 195 nursing homes in 12 states, 3,451 conventional dialysis treatments, and 10,246 MFD treatments. While the MFD population was sicker at baseline (lower hemoglobin, higher mean age, higher comorbidity score, more cerebrovascular disease and congestive heart failure), their discharge to home was 25% greater than those in the conventional dialysis group.
Read the abstract » | (added 2024-06-14)
Tags: Nursing Home, Frequent Dialysis, Skilled Nursing Facility, Discharge To Home Dialysis