Journal Watch

  1. The Brits are doing something right in home HD

    Among 166 home HD patients in Manchester, UK (chosen with "liberal selection criteria"), the drop-out rate was far smaller than we tend to see in the US. In 8 years, just 24 patients switched to a different option. Technique survival at home was 98.4% at 1 year, 95.4% at 2 years, and 88.9% at 5 years, excluding death and transplant. Patients older than 60, those with diabetes or heart failure, and those with more comorbidities were more likely to stop doing home HD. The technical error rate was just 0.7% per year.

    Read the abstract » | (added 11/06/2013)

    Tags: Hemodialysis

  2. One type of PD catheter offers a significant survival advantage

    Coiled? Swan neck? Straight? As it turns out, the catheter shape does matter. A new metaanalysis of 13 randomized controlled trials found that both catheters and people were twice as likely to survive when catheters were straight—not coiled.

    Read the abstract » | (added 11/06/2013)

    Tags: Peritoneal Dialysis

  3. PD First. It makes sense!

    Why is the default US dialysis standard in-center HD, when it doesn't offer the best outcomes, costs more, and offers a poor quality of life? That's the question asked in a new review article that points out the benefits of a PD first strategy. Rather than allowing ease of HD initiation to drive treatment "choice," it makes sense to change the default initiation option to PD.

    Read the abstract » | (added 11/06/2013)

    Tags: Peritoneal Dialysis

  4. Is there a new way to prevent PD infections? Sorry, honey

    Honey has a long history of helping to heal wounds—with no risk of antibiotic resistance. But, a recent trial of the sweet stuff in PD exit site infections did not show a benefit. Researchers asked 186 patients from 26 clinics in Australia and New Zealand to put purified honey on their exit sites, while a control group (185 people) used standard care (or mupirocin if they carried S aureus). The time to first infection was about the same in both groups.

    Read the abstract » | (added 11/06/2013)

    Tags: Peritoneal Dialysis

  5. What are the challenges for successful home HD?

    The UK has actually set a goal in 2002 for home HD of 10-15% of dialysis patients, but has not reached it yet. A new study (BASIC-HHD) is starting to look at the reasons for underuse of a treatment option that offers better results than standard in-center HD. A total of 500 patients will be followed, 200 pre-dialysis, 200 hospital HD, and 100 home HD from across the UK. The predialsyis patients will be followed for a year to better understand their journey to ESRD and renal replacement. They will be interviewed, take psychosocial assessments, and have blood tests. The researchers will also look at the attitudes and practices in dialysis clinics, the economics of home treatment, and care partner concerns.

    Read the abstract » | (added 10/02/2013)

    Tags: Hemodialysis

  6. Very tiny numbers of serious adverse events during home HD

    Ideally, no one on dialysis will ever run into a problem. But, when the blood needs be cleaned, sometimes things can go wrong. A new study from Canada looked at life-threatening events among 500 patient years among 190 people who were doing home HD. Researchers found one death and six other serious events (most involved blood loss). In five of the events, human error was involved. They calculated an adverse event rate of 0.06 per 1000 treatments. (Editor's note: unfortunately, we don't yet have a corresponding rate for adverse events for in-center HD, but it may be far higher.)

    Read the abstract » | (added 10/02/2013)

    Tags: Hemodialysis

  7. What does frequent HD do to the heart?

    In many people on dialysis, left ventricular hypertrophy or LVH (overgrowth of the heart's main pumping chamber) can lead to heart failure; a leading cause of death. In the Frequent Hemodialysis Network trial, 245 patients were randomized to receive standard in-center HD or frequent "daily" (six times per week) in-center HD. The nocturnal arm of the study randomized 87 patients to six nights per week of HD or three times per week standard home HD. In the daily trial, there were significant reductions in LVH—especially for those who still made some urine. There were no major differences in the nocturnal group (Editor's note: this arm of the study did not recruit enough people to draw statistical conclusions).

    Read the abstract » | (added 10/02/2013)

    Tags: Hemodialysis

  8. Nocturnal in-center HD comes to Slovenia

    Only a few handfuls of US clinics offer nocturnal in-center HD. Now, Slovenian researchers report their experience of switching 10 patients from "standard" (4-5 hours!) in-center treatments to thrice weekly 8-hour long nighttime ones. With almost twice as much dialysis per week, mean predialysis creatinine and urea dropped significantly, as did mean dry weight. Six of the ten were able to stop taking phosphate binders, and one more patient had a dose reduction—and phosphate was added to the dialysate for three patients. There were no major changes in predialysis blood pressure, calcium or potassium levels, mean ultrafiltration, hemoglobin, or EPO dose (Editor's note: perhaps because standard HD in Slovenia is longer, and because the nocturnal treatments were only three times per week).

    Read the abstract » | (added 10/02/2013)

    Tags: Hemodialysis

  9. The future of dialysis: Mini dialyzers with nanopores

    The smaller the dialzer, the more portable dialysis can become. Ultrathin silicon membranes have now been tried in mini dialyzers with nanopores. Coating the membrane with polyethylene glycol helps reduce activation of white blood cells without blocking the tiny pores.

    Read the abstract » | (added 10/02/2013)

    Tags: Chronic Kidney Disease

  10. PD may one day help stroke victims

    After an ischemic stroke that reduces blood flow, damage to brain cells can occur. High levels of the neurotransmitter glutamate in the blood—but not in brain cells—kills neurons. PD is known to remove glutamate from the blood. A new study in rats has found that using PD helped brain levels of glutamate to bounce back. In the rats, using PD shrunk the stroke damage area—and the rescued brain tissue still worked!

    Read the abstract » | (added 10/02/2013)

    Tags: Peritoneal Dialysis