Journal Watch
PD and Swimming
Australian nurses in 39 PD clinics conducted phone surveys. While only 77% of the clinics advocated swimming, nearly all had patients who did swim, mainly in sea water or a private pool. Covering the exit site and catheter with a waterproof dressing or ostomy bag was recommended, along with routine exit-site care. Several infections were linked with swimming.
Read the abstract » | (added 2019-10-14)
Tags: PD, Swimming, Exit Site, Waterproof, Infections
Sudden Cardiac Death (SCD) in PD vs. HD
A Korean registry analysis of 132,083 dialysis patients between 1985 and 2017 found that SCD caused 19.6% of the 34,632 deaths. Even after adjusting for age and significant comorbidities, HD was independently associated with SCD, as was diabetes.
Read the abstract » | (added 2019-10-14)
Tags: SCD, Sudden Cardiac Death, PD, HD
The Role of Frailty in Home Dialysis
Evaluation of frailty among 109 home dialysis patients revealed a greater than 2-fold increase in risk of a composite outcome that included technique failure and all-cause death. Weakness and weight loss were both linked with higher risk. “Assessing frailty as part of the clinical evaluation for home dialysis therapies may be useful for prognostication and clinical management,” report the authors.
Read the abstract » | (added 2019-10-14)
Tags: Frailty, Home Dialysis, All cause Death
PD Outcomes under the Medicare Expanded Dialysis Prospective Payment System
A Medicare change in 2011 may have increased the likelihood that clinics would expand PD to a broader population. Did this affect outcomes? A prospective cohort study compared 10,585 patients who started PD before payment reform, 7,832 interim patients, and 18,742 during the reform period. With similar demographics, more patients were treated in clinics with less PD experience—and these clinics had higher PD discontinuation rates. But, PD discontinuation fell overall, and mortality risk was stable.
Read the abstract » | (added 2019-10-14)
Tags: Expanded Dialysis Prospective Payment System, PD, Medicare
Home Dialysis: Better Outcomes at Lower Costs
Five years after starting dialysis, the population of Ontario, Canada over age 18 had mean 30-day PD costs 50% lower than in-center HD—and home HD costs 64% lower than in-center. After adjusting for covariates, home HD cost the least and had the highest survival (80%) vs. 52% on PD and 42% on in-center HD.
Read the abstract » | (added 2019-10-14)
Tags: Home Dialysis, PD Cost, HD Cost, HD Survival
RCT: Which Works Best, Straight or Coiled PD Catheters?
A metaanalysis recently found that straight catheters were better, and an RCT of 308 CAPD patients randomly assigned to receive a straight (n=153) or coiled (n=155) catheter corroborates that finding. After a mean follow-up of 21 months, straight PD catheters caused almost 9 times less dysfunction or drainage failure (0.7% vs. 5.8%) with less pain than coiled catheters. Both catheters had a similar risk of peritonitis.
Read the abstract » | (added 2019-09-11)
Tags: Catheter, Randomized Controlled Trial (RCT), PD, CAPD
Glycated Albumin vs. HbA1c Predicts Mortality in PD Patients with Diabetes
In patients on hemodialysis, glycated albumin (GA) reflects glycemic control and predicts all-cause mortality. A new retrospective, longitudinal observational study looked at GA in PD. Among 44 PD patients with diabetes matched to 88 HD patients with diabetes followed for 3 years, GA was a more precise way to measure glycemic control than hemoglobin A1c.
Read the abstract » | (added 2019-09-11)
Tags: Peritoneal Dialysis, All cause Mortality, Glycaemic Control, Glycated Albumin, Glycated Haemoglobin
BMI Alters Sodium Balance in PD
In a review of 439 PD patients, those with more urine volume, protein nitrogen appearance rate, fewer comorbidities, and higher BMI had greater sodium losses.
Read the abstract » | (added 2019-09-11)
A Patient on Home HD for 45 Years
A 62-year old Mississippi woman, one of the first home HD patients of Dr. John D. Bower, is reported to have been on home HD for 45 years now, a record.
Read the abstract » | (added 2019-09-11)
Tags: Home Hemodialysis, Quality Of Life, Long term Survival
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