Journal Watch
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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
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Systemic Immune-Inflammation Index (SII) and Mortality on PD
Among 1,419 PD patients from 2007 to 2019, SII was calculated as platelet count x neutrophil count/lymphocyte count. During a median 42 month follow up, 321 patients died, 171 of cardiovascular disease. Each 1 standard deviation increase in the SII was associated with a 20.2% rise in all-cause mortality and 28% in cardiovascular-specific mortality.
Read the abstract » | (added 2023-09-13)
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ISPD Proposes to Remove PD Toxin Clearance Targets
New ISPD Guidelines suggest that the focus of PD should be patient well-being—not lab values. This change would allow more people to do PD, and focusing on relieving uremic symptoms could help determine which solutes really do matter to quality of life.
Read the abstract » | (added 2023-08-16)
Tags: PD, Patient Well being, Lab Values, Uremic Symptoms, Quality Of Life
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2023 AJKD Core Curriculum in Nephrology
Acute PD, more use of home treatments, and better peritoneal solute transfer models are part of the content of the new Core, which emphasizes the latest data for prevention and management of infectious and noninfectious complications of PD.
Read the abstract » | (added 2023-08-16)
Tags: Acute PD, Core Curriculum, Complications Of PD, Home Dialysis
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Skilled Nursing Facility “Home” Dialysis Improves Rehabilitation
Rehab therapies take time—and so does going off-site for in-center dialysis. Offering more frequent dialysis (MFD) at SNFs saves time. Does it improve PT participation? Yes, finds a new retrospective EMR review study. Compared to 562 in-center HD rehab patients, 92 people who received MFD in their SNF had higher PT participation rates (equivalent to almost 13,000 non-ESRD rehab patients), even though they had significantly more comorbidities.
Read the abstract » | (added 2023-08-16)
Tags: Rehabilitation Therapies, Skilled Nursing Facility, MFD, SNF, PT Participation, Comorbidities
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Systematic Review of Culture-directed Antibiotics for Peritonitis
A review of 28 articles identified 18 antibiotics used for peritonitis, of which 9 (cefotaxime, ceftriaxone, daptomycin, ofloxacin, and teicoplanin in glucose-based solutions, tobramycin in Extraneal solution only and fosfomycin in Extraneal, Nutrineal, Physioneal 1.36% and 2.27% glucose solutions ) can be dosed interaperitoneally. Stability has not yet been demonstrated for all of these.
Read the abstract » | (added 2023-08-16)
Tags: Peritonitis, Antibiotics, Culture directed Antibiotics, Peritoneal Dialysis Solutions
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Disparities in Access to PD
Per logistic regression of USRDS data from 2009 to 2019, the incident PD population more than doubled, with increases in PD use by seniors. There was a 5% increase in PD use by Hispanic people, but no difference in other races. Urban PD use also increased by 5%, and 7% for those in socioeconomically disadvantaged areas.
Read the abstract » | (added 2023-08-16)
Tags: Incident PD, PD Access, Disparity, PD Demographics
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How Glucose Causes Peritoneal Fibrosis
Constant glucose exposure from PD dialysate often causes fibrosis that can make further PD impossible. High glucose causes chronic inflammation, interferes with lipid metabolism, and leads to angiogenesis and fibrosis. RAAS activation contributes to this process as well. There may be benefit to looking at the upstream pathways to see if there are ways to block fibrosis.
Read the abstract » | (added 2023-08-16)
Tags: High Glucose, PD Dialysate, Fibrosis
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Meta-analysis of Quality of Life by ESRD Treatment Modality
Analysis of 111 papers with more than 50,000 patients compared transplant, PD, home HD, and in-center HD for health-related quality of life outcomes. The rankings? Transplant, PD, home HD, in-center HD.
Read the abstract » | (added 2023-08-16)
Tags: Quality Of Life, ESRD, Treatment Modality