Journal Watch
The Q-Cohort Study: More Dialysis, Less Risk of Cancer
Uremic toxins increase cancer risk. In a study of 3,450 HD patients followed for 4 years, patients were divided into quartiles based on their baseline Kt/V. Four-year survival dropped linearly along with Kt/V. Every 0.1 increase in Kt/V reduced the risk of cancer death by 8%.
Read the abstract » | (added 2020-02-19)
Tags: Dialysis Dose, Cancer Death, Hemodialysis, Uremic Toxins, Kt/V
Green Nephrology: Reducing the Environmental Impact of Dialysis
Climate change and extreme weather events both increase the incidence of kidney disease and destabilize care. But, healthcare in general—and dialysis in particular—contribute substantially to greenhouse gases. Monitoring resources and reducing waste in HD can be done through reuse of RO reject water, renewable energy sources, better waste management, and slower dialysate flow rates. For PD, point-of-care dialysate will reduce the environmental impact.
Read the abstract » | (added 2020-02-19)
Tags: Environmental Change, Kidney Disease Factors, Environmental Impact Of Dialysis
Patient and Clinic Factors Driving Home Dialysis in Australia/New Zealand
Among 54,773 patients in 76 centers in the ANZDATA registry, an overall 45% (0-87%) were using some form of home dialysis. Males, people of color, and patients who were older, had comorbidities, experienced late nephrology referral, lived remotely, or were obese had lower uptake of home therapies. Smaller centers, those with shorter hours, and clinics who had fewer patients with permanent access had lower uptake as well.
Read the abstract » | (added 2020-02-19)
Survival with PD vs. Home HD and When to Go Home
Using a national cohort of 1,993 patients transitioning to home HD and 16,514 to PD between 2007 to 2011, 1,195 home HD were matched to 1,195 using propensity scores and adjusting for demographics, comorbidities, dialysis duration, and BMI. Those on home HD had significantly better survival (9.6 vs. 12.9 deaths per 100 patient-years; p<0.001). However, when patients switched to PD within the first 12 months of starting dialysis, survival was comparable between PD and home HD: patients who transitioned after 12 months had an 83% higher risk of death.
Read the abstract » | (added 2020-02-19)
Tags: Home HD, PD, Comorbidities, Dialysis Duration, BMI, Survival
Factors Associated with Fatigue in PD Patients
Analysis of fatigue scale data from 108 PD patients in China revealed that 78.7% suffered from fatigue, a number significantly higher than in the community population. Associated factors included sleep quality, normalized protein nitrogen appearance, transferrin, alkaline phosphatase, and total cholesterol levels.
Read the abstract » | (added 2020-01-09)
Tags: Fatigue, PD, Sleep Quality, Protein Nitrogen Appearance, Transferrin, Alkaline Phosphatase, Total Cholesterol Levels
Home HD: Hospitalizations and Technique Survival
In a Swedish registry study, patients initiating PD (n=456), home HD (n=152), and in-center HD (IHD; n=608) were matched by age, sex, comorbidity, and start date. Patients using home HD had significantly lower hospital admissions and days than those doing PD or IHD (1.7, 12 days vs. 2.8, 20 days and 2.2, 14 days respectively). Home HD patients also had significantly fewer admissions for cardiovascular diagnoses or infectious disease, as well as significantly longer technique survival.
Read the abstract » | (added 2020-01-09)
Tags: PD, Home HD, In center HD, Hospital Admissions, Cardiovascular Diagnosis, Infectious Disease, Technique Survival
First European Patients Using Nocturnal Home HD with Low-flow Dialysate
A retrospective analysis looked at 21 patients using low-flow dialysate for nocturnal home HD and followed for a minimum of 12 months. Participants had a mean dialysis duration of 28 hours per week; most used alternate nights and 50-60 L of dialysate per session. Use of phosphate binders and blood pressure medications was significantly reduced, and no patient safety events were reported.
Read the abstract » | (added 2020-01-09)
Tags: Low flow Dialysate, Nocturnal Home HD, Phosphate Binders, Blood Pressure Medication
A Novel Surgical Technique for Urgent Start PD
Placing a PD catheter with a double purse-string around the inner cuff was safe and feasible for urgent start PD, finds a study of 135 catheter insertions between 2011 and 2018. Double-cuffed straight Tenckhoff catheters were implanted surgically or semi-surgically using the double purse-string technique, and the incidence of leakages, dislocations, peritonitis, and exit-site infection were low. There were no bleeding events, bowel perforations, or hernia formations.
Read the abstract » | (added 2020-01-09)
Diabetes and the Risk of Peritonitis on PD
In contrast to earlier reports, a single-center study of PD patients between 1980 and 2012 (by era: 1980-’93, 1994-’04, 2005-12) found that while PD-associated peritonitis was higher among patients with diabetes in the earlier two eras, there were no differences in recent years.
Read the abstract » | (added 2020-01-09)
Tags: PD, Peritonitis, Diabetes
Low-dose IV Iron Sucrose for Treatment of Anemia in PD
A small study (n=18) of IV iron sucrose (200mg loading dose followed by 100mg monthly for 5 consecutive months) found reductions in ESA dosing for 5 patients and discontinuation in one, with no reported side effects.
Read the abstract » | (added 2020-01-09)
Tags: IV Iron Sucrose, Anemia, ESA Dosing