The Clinical Experience of In-center Nocturnal HD

An analysis of 4 years of INHD looked at 12 patients who chose to stop, 24 patients who continued, and interviews with patients and staff. A “starter pack” given to aid sleep in new INHD patients was well-received and sleep was not a reason to stop INHD. Staff were most concerned about emergency support, though staffing ratios were the same as during the day. Most of the clinical incidents for INHD centered around communication with patients and families, patient transfer delays, and equipment issues—not medical interventions, infection control, and transport, as during the day. Those who continued with INHD felt they had more social time and perceived health benefits.

Read the abstract » | (added 2021-07-12)

Tags: INHD

Roxadustat for Anemia in PD

The anemia drug was tested in 129 people on PD randomized to roxadustat or other ESAs for 24 weeks. The roxadustat group had a 96% response rate (vs. 92%), lower hepcidin levels and higher TIBC. Total cholesterol and LDL dropped more with roxadustat, independently of C-reactive protein. Mean average hemoglobin on roxadustat were 11.5 g/dL (vs. 11.2). There were some common adverse events.

Read the abstract » | (added 2021-07-12)

Tags: Prolyl Hydroxylase Inhibitor, Erythropoiesis, Iron Metabolism, Anemia

Higher HD Dose Linked with Better Survival

A national registry of 32,283 standard HD patients found that “a higher dose of dialysis was consistently associated with better survival.” Kt was most discriminating, with survival highest in the upper Kt quartile. Arteriovenous access, hemodiafiltration, scheduled dialysis initiation, and long weekly HD hours predicted higher Kt.

Read the abstract » | (added 2021-07-12)

Tags: Dialysis Frequency, Survival, Kt, Mortality

Genes Help Predict Peritoneal Transport Rates

Among 2,850 people on PD who had complete genetic data, 5 single nucleotide variants at four loci had suggestive associations with the peritoneal solute transfer rate (PSTR), in particular rs28644184 at the KDM2B locus.

Read the abstract » | (added 2021-07-12)

Tags: Genetic Variants, Peritoneal Solute Transfer Rates, Kidney Failure, Peritoneal Dialysis

Funding U.S. Dialysis Innovation: The Role of TPNIES

CMS is expanding reimbursement to encourage use of home treatments under the transitional add-on payment for new and innovative equipment and supplies (TPNIES). An up to 26% reimbursement to clinics requires machines to be eligible under the substantial clinical improvement (SCI) criteria—but these have not been adapted for home dialysis and may not be suitable.

Read the abstract » | (added 2021-06-15)

Tags: Home Dialysis, Transitional Add on Payment For New And Innovative Equipment And Supplies, TPNIES

In-center Nocturnal HD Improves Quality of Life vs. Standard In-center HD

A small prospective cohort study of standard in-center HD patients (n=36) who switched to in-center nocturnal HD compared baseline health-related quality of life to levels 12 months later. Among the 24 who completed the study and permitted follow up, the mental component score increased by 7.1 points, and improvements were seen in several domains.

Read the abstract » | (added 2021-06-15)

Tags: In center Nocturnal Hemodialysis, Health related Quality Of Life, End stage Renal Disease, KDQOL 36

Home vs. In-center HD Outcomes from a Matched Cohort

After adjusting for BMI, smoking, race, and comorbidities, home HD came out ahead of in-center HD when 181 home HD patients were matched to 413 using in-center HD. With home HD, the risk of death was significantly less, and phosphate levels were significantly lower. There were no major differences in transplant rates, graft survival, hemoglobin, calcium, or PTH levels.

Read the abstract » | (added 2021-06-15)

Tags: Dialysis Modality; End stage Kidney Disease; Haemodialysis, Hemodialysis, Home Haemodialysis, Home Hemodialysis, Mortality

PD vs. Standard In-Center HD for Stroke Risk: A 14-year Study

Of 7,916 ESRD patients with atrial fibrillation between 2001 and 2013, data from 363 PD and 5,302 HD patients were analyzed. At 1 year, 3 years, and 5 years, the participants who used PD had significantly lower risks for outcomes including stroke, major bleeding, and intracranial hemorrhage than those using HD.

Read the abstract » | (added 2021-06-15)

Tags: ESRD, End Stage Renal Disease, Atrial Fibrillation, Peritoneal Dialysis, Hemodialysis, Patient Outcomes

PDOPPS Findings of Factors Important to Peritonitis Outcomes

The Peritoneal Dialysis Outcomes and Practice Patterns Study analyzed factors in the outcomes variations among 1,631 peritonitis episodes in 1,190 patients in seven countries. About 2/3 of the bouts were successfully cured, which was more likely with Gram-positive organisms, automated PD, and use of icodextrin (facility level), aminoglycosides, and ciprofloxacin vs. ceftazidime for Gram-negative organisms.

Read the abstract » | (added 2021-06-15)

Tags: Peritoneal Dialysis, Peritonitis, Peritoneal Dialysis And Outcomes Practice Patterns Study

Safety Study of the PD Automated Wearable Artificial Kidney

In the AWAK pilot study, 15 participants used up to nine sessions over 72 hours and were then followed for one month. There were no serious adverse events, but 60% of participants had abdominal pain and 47% reported bloating. Median body weights were not significantly different before and after the study. Device enhancements will address ultrafiltration and pain.

Read the abstract » | (added 2021-06-15)

Tags: Wearable Kidney, Artificial Kidney, Chronic Kidney Disease, Peritoneal Dialysis