Journal Watch
Nephrologist Attitudes Toward Home Therapies Drive Practice
A survey of 327 nephrologists assessed their knowledge, attitudes, and practice around the choices for renal replacement therapy. Attitudes toward PD, HD, and transplant were independently linked to participants’ consideration of these options for patients.
Read the abstract » | (added 2023-04-19)
Tags: Nephrologists Modality Knowledge, Modality Bias, Choices For Renal Replacement Therapy, Modality Choice, Patient Education, Shared Decision making
KDIGO Home Dialysis Controversies Conference
The report from the May, 2021 KDIGO conference on increasing use of PD and home HD has been released. Attendees agreed that shared decision-making was ideal, everyone should have access to home therapies, and alignment of policies and resources must occur to make these goals happen.
Read the abstract » | (added 2023-02-13)
Tags: Modality, Treatment Satisfaction, KDIGO, Shared Decision making
5-year Assisted PD Program Outcomes
Not everyone can do solo PD—or has a partner. In BC, Canada, a pilot staff-assisted PD program began in 2016. Analysis of 5 years of data from 322 patients found growth to 11.2% of the total PD population, with a median time of 13.6 months on PD. More than 1/3 were able to use the service until they died.
Read the abstract » | (added 2023-02-13)
Serum Phosphorus and Survival on PD
Data from 5,847 PD patients between 2014-2017 from seven countries in the PDOPPS study found that compared to an optimal range of 3.5-4.5mg/dL, the hazard ratio (HR) for all-cause mortality was 19% higher when phosphorus was 5.5-6.5 and 53% higher when phosphorus was greater than 6.5. When 6 months of data were examined, the linkage was even stronger.
Read the abstract » | (added 2023-02-13)
Tags: PD, Serum Phosphorus, PDOPPS, Hazard Ratio, All cause Mortality
Do More Hours of HD Benefit Older Patients, Too?
Analysis of ANZDATA registry data of patients who started dialysis at age 65 and older from 2005 to 2015 say YES—hours of HD do matter to survival. Among 8,224 people, those whose HD sessions were 5 hours or longer had an 81% reduction in the hazard risk of death vs. those who only got 4-4.5 hour treatments (p < .001).
Read the abstract » | (added 2023-02-13)
Tags: HD, ANZDATA, HD Hours, Session Length, Survival Rate
44 Years of Home HD Technique Survival in Valencia, Spain
In Valencia, 13.4% of patients on dialysis were using home HD in 2018. Researchers compared home HD data from two eras: “ancient” (1976-2000) and “modern” (2001-2020). Interestingly, 1- and 2-year patient survival were superior in the modern era (87.3% vs. 83.7% for 1-year; 83% vs. 77.4% for 2-year)—but 5-year survival was better in the ancient era (61% vs. 47.8%), as patients aged. Technique survival was better at every point in the modern era.
Read the abstract » | (added 2023-02-13)
A Safety Framework to Address Risk Factors for Home HD Dropout
In an effort to pre-emptively identify and reduce drop out risks from a new home HD program, a clinic in Singapore undertook failure mode and effects analysis (FMEA). They listed each key process and sub-process, scored them for failure mode, and designed solutions. The transition from in-center to home HD was found to have the highest failure risk, in 59 areas, so two teams with different clinical experience developed a safety framework.
Read the abstract » | (added 2023-01-10)
Tags: Home HD, Risk Factors, Drop Out Risk, Failure Mode And Effects Analysis, Safety Framework
Video-based vs. Traditional PD Training: Which is Better
PD could be expanded more quickly if training did not have to be done one-on-one in person. In Italy, Videodialysis has been used since 2016 for remote patient and care partner training, after an initial home visit. In a small series (46 trainings; 21 at home and 25 by video), the video technique was found to be as effective as traditional training with fewer home visits.
Read the abstract » | (added 2023-01-10)
Tags: PD Training, Videodialysis, Home Visits, Telemedicine
New PD Prescription Core Curriculum Update for 2023
Individualizing PD to align with patient lifestyle preferences should take precedence over small solute clearance targets, say global PD experts.
Read the abstract » | (added 2023-01-10)
Tags: Individualized PD, Patient Lifestyle, Solute Clearance, PD Prescription
Frequency of Sexual Dysfunction on PD
A study enrolled 201 people who did CAPD for 3+ months (49 females and 65 males), with slightly more than half (n=114) under age 65). Gender-appropriate surveys administered in person, along with the SF-36 and Beck Depression Inventory (BDI) revealed that almost 90% of women and almost 88% of men reported sexual dysfunction. Depression was highly prevalent as well. The authors concluded that not discussing and treating sexual dysfunction could adversely affect quality of life.
Read the abstract » | (added 2023-01-10)
Tags: CAPD, Depression, Sexual Dysfunction, Quality Of Life