Journal Watch
Physical Activity May Reduce Bone Density in PD
In a paradoxical finding, 13 women and 21 men on PD who were sedentary had higher BMD than those who were moderately or vigorously physically active. Other aspects of body composition and biochemistry, such as creatinine clearance and triglyceride levels were linked with higher levels of physical activity.
Read the abstract » | (added 2020-10-12)
Survival Benefit of More HD Hours is Not Sustained After a Switch Back to Standard
In the ACTIVE Dialysis trial, 200 standard HD patients were randomized to receive usual care (median of 12 hours of HD/week) or extended hours (median of 24 hours of HD/week) for 12 months, with follow up through 60 months. After the 12 months, intervention group participants were switched back to usual care. At 5 years, there was no difference between the groups in all-cause mortality.
Read the abstract » | (added 2020-10-12)
Tags: Dialysis, End stage Kidney Disease
Pilot: Chlorhexidine-impregnated Sponge Dressings to Prevent Exit Site Infections
In a single-center study, 50 incident PD patients were taught to use a weekly chlorhexidine dressing on their exit sites, and followed for a year. While 12% developed contact dermatitis, 73% found the dressings acceptable. Episodes per patient year of exit-site/tunnel infections and peritonitis were 0.09 and 0.07, respectively, while 1-year technique and patient survival rates were 86% and 96%, respectively.
Read the abstract » | (added 2020-10-12)
Tags: Chlorhexidine Dressing, Exit site Infection, Peritoneal Dialysis
24-hour Dietary Recall Less Accurate for Protein Intake Assessment in PD
Among 50 PD patients, use of protein nitrogen appearance (PNA) revealed levels of protein that ranged from 48.27-67.74 grams per day; median 55.75—while 24-hour dietary estimated the levels at 45.28-87.40; median 61.43 g/day. The authors suggest that proportionality bias may have influenced the results.
Read the abstract » | (added 2020-10-12)
Tags: Dialysis Initiation, Dialysate, Peritoneal Dialysis, PD
International Use of PD
Worldwide PD use is approximately 11%, which varies across the globe, finds a new survey of stakeholders in 182 countries (with 313 respondents from 160 countries). Median PD use was 38.1 per million. Thirty countries, mainly low-income, did not offer PD, while in 69% of countries, PD was the first modality for <10% of incident patients. The range of PD costs passed on to patients was 1-25%, with higher co-pays in South Asia and low-income countries. Patient-reported PD outcomes were rarely measured.
Read the abstract » | (added 2020-09-11)
PD vs. Standard HD for Cognitive Function
A metaanalysis of papers including 195,774 patients looked at whether PD or standard in-center HD better supported cognitive function. The authors found significantly less risk of cognitive impairment among those who did PD.
Read the abstract » | (added 2020-09-11)
Tags: Cognitive, Renal Failure
Impact of Depression on PD Patient and Technique Survival
Among 275 patients who had done CAPD for at least 3 months, 31.3% tested as having depressive symptoms. Long-term patient and technique survival were significantly poorer in this group, even adjusting for cofounders.
Read the abstract » | (added 2020-09-11)
Benefits of PD Remote Monitoring
A retrospective study compared two groups of APD patients, one that received remote monitoring (n=38) and one that received routine care (n=35). PD dropout and fluid status were similar between the two groups. But, the remote monitoring group had fewer ER and hospital visits related to kidney disease, especially among those with more comorbidities. Patients also preferred remote monitoring, and were more satisified with their care.
Read the abstract » | (added 2020-09-11)
Tags: Clinical Outcomes, Quality Of Life, Remote Monitoring, Telemedicine
PD and Bone Mineral Disorders vs. HD
Body composition, nutritional status, DEXA, and bone mineral disease (BMD) biomarkers were assessed at baseline and one year in 242 ESRD patients starting either PD (n=138) or HD (n=104). Among HD patients, BMD decreased significantly—but not in PD patients. Preservation of BMD was associated with significantly lower all-cause mortality, with cortical bone preservation more predictive than trabecular bone preservation.
Read the abstract » | (added 2020-09-11)
Tags: End stage Renal Disease, Bone Mineral Density, Dialysis
International Use of HD—Including Home HD
A new survey of stakeholders in 182 countries (with respondents from 160 countries) found a use rate for HD of 298.4 per million. Among incident dialysis patients, the HD rate was 98.0. Standard in-center HD was available among 27% of low-income countries (and these patients paid more of the costs); home HD was available in 36% of high-income countries. Monitoring of patient-reported outcomes was done in 61% of countries, while 60% monitored bone minerals and patient survival, and 51% monitored technique survival. Just 5% of countries initiated patients on HD with arteriovenous access.
Read the abstract » | (added 2020-09-11)
Tags: Hemodialysis, Homedialysis, HD