Journal Watch
Use of CMS-reimbursed CKD Education Doubles the Likelihood of Home Dialysis
While Medicare has paid for stage 4 CKD kidney disease education (KDE) since 2010, only a tiny fraction have used it—but KDE matters, finds an analysis of 369,968 patients who started dialysis between 2010 and 2014. Just 3,469 (0.9%) had received at least one KDE session, but compared to controls matched for age, gender, ESRD Network and year of dialysis start, they were twice as likely to have started a home dialysis treatment. Concerningly, African American and Hispanic patients were significantly less likely to have received KDE services.
Read the abstract » | (added 2020-12-10)
Tags: Home Dialysis, Kidney Disease Education, Peritoneal Dialysis
Are In-center Hemodialysis Patients Interested in Self-Care?
In-center self-care can be a bridge to home hemodialysis. A survey of 91 patients and 31 nurses revealed higher interest among the patients than the nurses (2.43+0.93 vs. 2.19+0.77). Patients also considered themselves to be capable of performing self-care tasks. Greater interest and perceived capability were linked with years of education, patient activation, disease severity, and age.
Read the abstract » | (added 2020-12-10)
Tags: Renal Dialysis, Self‐care, Self‐management
Exercise May Improve Residual Kidney Function in PD
A post-hoc study of a 12-week randomized controlled trial of home exercise for PD patients eliminated those with anuria (n=18) and analyzed 13 patients in the usual care group and 16 in the exercise group. Two RKF markers, liver-type fatty acid-binding protein (L-FABP) and the microalbumin-to-creatinine ratio, were significantly lower in the exercise group.
Read the abstract » | (added 2020-12-10)
Nephrology Fellows Not Ready for Home Dialysis
Even nephrology fellows attending home dialysis conferences did not feel prepared to care for PD or home HD patients, finds a small study. Of 110 attendees, 76 (66%) completed a survey about their confidence with regard to management of home dialysis. Most were “moderately” confident about PD principles—though just 11% had seen a PD catheter insertion, and only 3% had initiated a patient on urgent start PD. Most had “low” confidence in their ability to manage home hemodialysis.
Read the abstract » | (added 2020-12-10)
Prolonged PD Training Linked with Higher Peritonitis Risk
A single center retrospective analysis of all PD training sessions from 2001 to 2018 (135 patients) found that the 23% whose training lasted longer than 13 sessions had a significantly higher risk of peritonitis, though technique survival was not reduced. Factors associated with prolonged PD training included older age, diabetes, and unemployment.
Read the abstract » | (added 2020-12-10)
Which Form of PD Has a Higher Risk of Peritonitis?
If you guessed CAPD because there are more exchanges to perform, you are correct, finds a study that matched 106 APD to 106 CAPD patients and followed them for 3 years. During the study period, there were 64 cases of peritonitis, and the risk was 30% higher among those who did CAPD.
Read the abstract » | (added 2020-11-12)
Tags: PD, Peritoneal Dialysis, CAPD
Quanta SC+ Efficacy and Safety
A human factors test of the Quanta SC+ of 60 patients in the UK (1,333 treatments) using conventional, thrice weekly schedules had no serious adverse events. Ultrafiltration was within acceptable limits.The threshold standardized Kt/V was exceeded in 94% of treatments, and in 97.6% of patients who did not have significantly residual kidney function.
Read the abstract » | (added 2020-11-12)
PD vs. HD for Quality of Life
Eleven studies from 2000 to 2019 (N=3,711) comparing PD with in-center HD (ICHD), PD vs. home HD, ICHD vs. self-care ICHD, ICHD vs. home HD, and various home HD modalities with each other were analyzed to determine the impact of modality on quality of life. PD was favored in some domains, while ICHD was favored in others. Home HD was rated significantly higher than ICHD for some domains.
Read the abstract » | (added 2020-11-12)
Tags: Dialysis, Dialysis Choice, PD, HD
Complications in Planned vs. Unplanned Peritoneal Dialysis Starts
A metaanalysis of 14 papers totalling 2,401 PD patients looked at the outcomes and safety of unplanned PD starts within 7 days of catheter placement vs. 7-14 days. Early-start PD was linked with more leaks, omental wrap, and—for CAPD—catheter malposition. There were no significant differences in infectious complications, but the risk of transition to HD and mortality were higher. More studies are needed.
Read the abstract » | (added 2020-11-12)
Warming PD Fluid to Body Temperature Does Not Improve Clearance
There may not be a clear benefit to warming PD fluid to body temperature, suggests a small (N=18) single blind randomized controlled trial. Participants were assigned to have a peritoneal equilibrium test with fluid at 37°C or warmed with conventional methods. The two groups had similar outcomes for peritoneal clearance, abdominal discomfort, body temperature, blood pressure, and other parameters.
Read the abstract » | (added 2020-11-12)