Journal Watch
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Home HD Dose and Frequency Prescriptions
Current Kt/V formulas don’t guide nephrologists to prescribe home HD with low-flow machines. A study of 38 home HD patients resulted in 231 clinical data sets for urea modeling, which were analyzed using the Solute Solver software recommended by the KDOQI guidelines. The researchers chose 7 of the 62 potential combinations, assuming Monday blood draws, and found the new formula for stdKtV to be reliable and helpful for guiding clinicians.
Read the abstract » | (added 2023-10-13)
Tags: Home HD, Kt/V, Urea Modeling, StdKt/V
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Longer Survival with Extended Home HD
A study in Turkey compared 348 patients doing extended home HD (418 minutes) matched with 1,047 doing standard in-center HD (242 minutes) and followed both groups for about 55 months. The extended home HD patients had an all-cause mortality rate of 3.76 per 100 patient years—vs. 6.27 for the in-center HD patients; a significant 40% reduction.
Read the abstract » | (added 2023-10-13)
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Magnesium Inhibits the Peritoneal Calcification of Late-stage EPS in Mice
Encapsulating peritoneal sclerosis (EPS) is a devastating and potentially lethal complication of PD. The reasons for EPS are not clear, but phosphate loading seems to contribute to the condition. This study successfully induced peritoneal calcification in mice—and found that administering magnesium into the peritoneum suppressed fibrosis and calcification.
Read the abstract » | (added 2023-10-13)
Tags: Encapsulating Peritoneal Sclerosis, Magnesium, Peritoneal Calcification, EPS
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Melatonin Shows Promise for Preventing Peritoneal Fibrosis
Glucose in peritoneal dialysate drives inflammation and angiogenesis, which lead to fibrosis that can cause loss of use of the membrane. A new study from China proposes that melatonin may break this cycle.
Read the abstract » | (added 2023-10-13)
Tags: Melatonin, Peritoneal Fibrosis, Glucose, GSDME, Pyroptosis
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Exercise and Quality of Life on PD
In a cross sectional study of 339 PD patients, 81.7% exercised a median of 5 hours per week, mainly slow walking. Those who exercised had better quality of life. Older age, female sex, higher BMI, and pain were independently associated with lower exercise capacity.
Read the abstract » | (added 2023-10-13)
Tags: PD, Exercise, Quality Of Life
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Hypocrisy in Healthcare—Professional vs. Patient ESRD Modality Choices
An anonymous online UK survey of renal healthcare workers had 858 responses to two hypothetical questions about their own dialysis modality choice. While PD and home HD were strongly preferred, more than 80% of ESRD patients in the UK still receive standard in-center HD.
Read the abstract » | (added 2023-09-13)
Tags: Dialysis Modality, ESRD Modality
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Outcomes with PD to HHD Compared to Direct HHD
Analysis of data from all patients who started PD or HHD in the first 90 days of kidney replacement therapy in Canada matched PD+HHD patients (n=163) 1:1 to incident HHD patients (n=711). Interestingly, while hospitalization risk was similar, clinical outcomes were better in the PD+HHD group.
Read the abstract » | (added 2023-09-13)
Tags: PD, HHD, Kidney Replacement Therapy, Clinical Outcomes
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Incremental PD and Quality of Life
In a 4-year study (2015-2019) of adults starting PD and followed for one year, those who used incremental PD had better KDQOL physical composite, burden of kidney disease, and effects of kidney disease scores, as well as less hospitalization and lower mortality rates (non-significant).
Read the abstract » | (added 2023-09-13)
Tags: Incremental PD, KDQOL, Mortality Rate, Quality Of Life
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Early Survival Advantage for Incremental PD
From 2008 to 2017, 1,315 patients from one hospital who started PD were enrolled in a study that propensity matched them 1 (incremental; n=285):2 (full dose; n=502) for age, sex, residual kidney function and urine volume, hemoglobin, serum albumin, and other variables. For the first 6 years, intermittent PD had significantly better survival than full dose PD, with a 39% lower risk of all-cause mortality and 41% less cardiovascular mortality. This advantage disappeared with longer time on PD.
Read the abstract » | (added 2023-09-13)
Tags: Intermittent PD, Full Dose PD, Mortality
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Intraperitoneal Pressure and Hernias
While it has long been believed that high intraperitoneal pressure (IPP) is a factor in hernia development, this notion had not been proven. A prospective observational study of 124 incident PD patients over a 10-year period suggests that the common wisdom was correct. Higher IPP at PD onset, older age, higher BMI, prior hernia, laparoscopic PD catheter placement, and technique failure were related to hernia formation.
Read the abstract » | (added 2023-09-13)
Tags: Intraperitoneal Pressure, IPP, Hernia, Incident PD, Hernia Formation Factors