Journal Watch
Impact of Assisted PD
A retrospective look at 1,576 incident patients at one clinic between 2002 and 2017 examined the effects of offering assisted PD on the rates and cumulative incidence of PD starts. Those who used assisted PD tended to be older. Use of the program significantly increased the rate of PD initiation, but there was a fall in usage over time.
Read the abstract » | (added 2020-04-13)
Tags: Renal Replacement Therapy, Assisted Peritoneal Dialysis
Cardiovascular Benefits of Benefits
A review considers the impact of nocturnal HD on cardiac remodeling, myocardial stunning, hypertension, heart rate variability, sleep apnea, coronary calcification, and endothelial dysfunction.
Read the abstract » | (added 2020-04-13)
Tags: Benefits, Cardiovascular, Home Hemodialysis, Myocardial Stunning, Nocturnal Hemodialysis, Vascular Calcification, Cardiovascular Disease
Effect of a Nurse-led Program on PD Nutritional Status
In a controlled trial, 203 PD patients were randomly assigned to a study or control group. The study group received health education, treatments, case management, and nurse-led surveillance based on the Omaha system. The control group received usual care. After intervention, the study group had significantly more well-nourished patients (6.19% to 29.9%), and several other parameters were significantly improved as well. Hemoglobin, albumin, and pre-albumin were also significantly higher in the study group.
Read the abstract » | (added 2020-04-13)
Tags: Peritoneal Dialysis, Dialysis, Chronic Kidney Disease, Nursing, Nutritional Status, Omaha System
Outcomes Between Urgent-start PD and HD
Urgent-start PD (n=93) and urgent-start HD (n=91) patients similar in age, diabetes and other comorbidities, and lab values, were followed for 6 months to 2 years. Rates of mechanical complications, bacteremia, and survival were comparable. Exit site/access infections were significantly higher in the PD patients, but those on PD had significantly better residual kidney function and phosphorus control, and used significantly less erythropoietin and antihypertensives
Read the abstract » | (added 2020-04-13)
Tags: Haemodialysis, Renal Function Recovery, Peritoneal Dialysis, Urgent Start
Why Early Survival on PD Matters
If survival between PD and standard in-center HD “evens out in the end,” does it matter? Yes, argues Mark Marshall, MD, from New Zealand. The early survival benefit increases patient life years—and persists even when accounting for use of central venous HD catheters. To support shared decision-making, patients have the right to know about survival on PD vs. standard HD.
Read the abstract » | (added 2020-03-16)
Tags: Survival, PD, In center HD, Early Survival, HD Catheter
Double Purse String Suture for Urgent Start PD Catheters
An Italian article reports that use of a double purse-string technique allowed immediate CAPD starts within 24 hours of catheter placement, with no difference in complications (mechanical or infectious) or catheter survival between surgical or trocar placement.
Read the abstract » | (added 2020-03-16)
Tags: Double Purse string, CAPD Starts, Catheter Placement, Catheter Survival
Glucose Degradation Product (GDP) Disrupts Peritoneal Membrane Function
Growth of new, immature blood vessels on the peritoneal membrane is linked with ultrafiltration failure. Exposure to the GDP methylgyoxal (MGO) up-regulated both vascular endothelial growth factor (VEGF) and suppressed platelet-derived growth factor (PDGF) in vitro, potentially disrupting the balance of angiogenesis.
Read the abstract » | (added 2020-03-16)
Tags: Peritoneal Membrane, Ultrafiltration Failure, Methylgyoxal, Angiogenesis
Physician Reimbursement Increases Did Not Drive PD in Canada
Among a cohort of 4,262 patients in Alberta, Canada followed between 2001 and 2014, an increase in PD physician pay from $0 to $135 (over a 9-year period) revealed no statistical evidence of a difference in PD use or trends—and the role of the physician in modality selection was unclear.
Read the abstract » | (added 2020-03-16)
Tags: PD Physician Pay, PD Use Trend
Glucose and Peritonitis
A prospective, longitudinal cohort study followed 105 PD patients for up to 5 years (mean of 23 months). Higher glucose exposure significantly predicted peritonitis, and patients with more residual kidney function also had a significantly longer time to first bout of peritonitis. Read the abstract. The authors suggest using the lowest concentration of glucose possible.
Read the abstract » | (added 2020-03-16)
Peritonitis with Diarrhea Could be C-diff
Cloudy PD dialysate can signal infectious peritonitis from a variety of causes—including C-diff. But, use of cephalosporins could worsen a C-diff infection. A new article presents two case histories of C-diff peritonitis and suggests reexamining the traditional empiric treatment of peritonitis when diarrhea is present.
Read the abstract » | (added 2020-03-16)
Tags: PD Dialysate, Infectious Peritonitis, C diff, Cephalosporins, Empiric Treatment, Diarrhea