Payment Policy is Driving Increases in U.S. Home Dialysis

Follow the money. Analysis of 523,526 patients starting dialysis in the U.S. between 2005 and 2013 found increases in home dialysis use in all groups, and a decline in racial/ethnic differences in home dialysis. However, over time, white patients had an increase in mortality compared to minority patients, while transplant rates remained lower in minority patients.

Read the abstract » | (added 2019-08-14)

Tags: Home Dialysis Outcomes, Racial, Ethnic, Mortality, Transplant Rates

Remote PD Monitoring Reduced Hospitalizations

A study of people starting automated PD matched patients who did and did not receive remote patient monitoring (RPM), with 63 patients in each group. Those who received RPM had significantly fewer hospital stays and days.

Read the abstract » | (added 2019-08-14)

Tags: Automated PD, Remote Patient Monitoring, Hospitalization

Challenges in Assessing Survival of In-center vs. Home HD

It’s treatment time that matters, not location—of course—suggests a new thorough review of the survival data. And, while it is challenging to prove a survival benefit when all home HD is so often conflated (short daily vs. nocturnal, for example), quality of life is demonstrably better—and matters more to patients.

Read the abstract » | (added 2019-08-14)

Tags: Treatment Time, Survival Data, Modality, Quality Of Life

High Fiber Diet May Save Lives on PD

A study of 881 PD patients followed for up to 12 years found that participants who ate more fiber tended to be younger, male, and have more residual kidney function. In those who did not have diabetes, each 1 gram increase in daily fiber intake independently predicted improved survival by 13%.

Read the abstract » | (added 2019-08-14)

Tags: Chronic Kidney Disease, Dietary Fiber, Mortality, Peritoneal Dialysis

PD: Better Quality of Life than In-Center HD for 2 Years

Among 989 patients starting PD or in-center HD, health-related quality of life (HRQOL) was measured at 3, 12, and 24 months after dialysis start. PD patients scored higher all along on several key dimensions than HD patients—and this effect lasted up to 2 years. Both PD and HD patients had about the same amount of decline in HRQOL over 2 years.

Read the abstract » | (added 2019-08-14)

Tags: HRQOL, PD, In center HD, Quality Of Life

Some PD PETs Are Better Than Others

There are three ways to do a peritoneal equilibrium test (PET) to measure how well someone’s peritoneum is able to transport water and wastes. Compared to a traditional PET, a modified PET had good agreement in 21 patients—but the so-called mini-PET did not.

Read the abstract » | (added 2019-08-14)

Tags: Peritoneal Equilibrium Test, PET, Peritoneal Membrane Transport

Impact of daily low-flow HD on potassium and lactate levels

In the NxStage FREEDOM study, 345 patients switched from standard in-center HD to daily, low-flow HD. Blood levels of potassium and lactate were analyzed during the last 3 months of standard HD and the first 3 months of daily HD. On daily HD, predialysis serum potassium decreased significantly at a dialysate potassium level of 1 mEq/L, with no change at 2 mEq/L. Predialysis serum bicarbonate level decreased significantly with dialysate lactate concentration of 40 mEq/L—but increased significanty at 45 mEq/L. Choosing the correct dialysate for the patient is important.

Read the abstract » | (added 2019-07-15)

Tags: Daily HD, Potassium, Bicarbonate, Dialysate

In-center HD patients tend to overestimate how long they are likely to live

Statistics do not apply to individuals. However, a survey of 996 standard in-center HD patients from 31 clinics found that most could not correctly guess how long other “people your age with similar health conditions” usually live (<5 years, 5-10 years, >10 years, not sure). Just 11.2% chose <5 years, when the USRDS results would suggest 60.3%. Those who believed they would live longer were less likely to have advance directives.

Read the abstract » | (added 2019-07-15)

Tags: Life Expectancy, Patient Education

Incremental PD may preserve residual kidney function longer

A single-center observational study in Korea followed 347 patients; half started full-dose PD and half started incremental PD. While patient, technique, and peritonitis-free survival were similar between groups, the incremental PD group had a significantly lower risk of losing all of their kidney function (anuria).

Read the abstract » | (added 2019-07-15)

Tags: Full Dose PD, Incremental PD, Residual Kidney Function

How longer HD treatments affect bone minerals

The ACTIVE study randomized 200 people to do 24+ hours of HD per week vs. standard (<18 hours per week) HD. Long HD treatments reduced serum phosphate levels, but did not change PTH or serum calcium. In a second analysis of the data, those who did longer HD needed fewer phosphate binders as well.

Read the abstract » | (added 2019-07-15)

Tags: HD Duration, Long Hd Treatment, Serum Phospate, Mineral Metabolism, Phosphate Binders