Journal Watch
Starting PD with One Daily Exchange of Icodextrin
Incremental PD can be less restrictive for patients initiating therapy. Is one daily exchange with icodextrin enough? A physiological study used a 3-pore kinetic model to assess fluid and solute removal among patients with residual function that ranged from 0 to 15 mL/min/1.73m2. All but very large patients (total body water >60L) were predicted to achieve adequate dialysis with this approach.
Read the abstract » | (added 2018-02-15)
Avoiding Short-term HD with Lower PD Abdominal Pressure
When PD patients have hernias, leaks, surgeries, etc., they are often told that they must switch to HD temporarily—using a central venous catheter. Another approach, reducing intraabdominal pressure, may reduce the need for HD, decrease morbidity, and minimize cost.
Read the abstract » | (added 2018-02-15)
Tags: Hernias, Leaks, Surgeries, Intraabdominal Pressure
LVAD Users – A New Group Who Can Benefit from Home HD
Patients who need a left ventricular assist device prior to heart transplant surgery may develop acute kidney injury as well. Instead of standard in-center HD, a first patient has been trained for and is successfully doing home HD while waiting.
Read the abstract » | (added 2018-02-15)
Tags: Left Ventricular Assist Device, Heart Transplant Surgery, Acute Kidney Injury
Nephrology Fellows Need Home HD Training & Experience
Home HD offers research and quality improvement topics for fellows, but lack of training is a barrier to patient use of this option. Fellows should attend lectures and receive at least 6-12 months of outpatient clinical exposure that includes transitioning three or more patients to home, argues a new op ed. Having a passionate home HD expert and advocate is essential, as is exposure to home HD nurses.
Read the abstract » | (added 2018-02-15)
Standard Kt/V urea Targets Less Useful for Home HD
When patients do home HD more often than three times a week, do the Kt/V urea targets still predict outcomes? Not all that well, suggests a new study. Multivariate regression analysis of 109,273 standard in-center HD patients compared to 2,373 home HD patients found that while a lower Kt/V urea (<2.1) did predict higher blood pressure in both groups, it did not predict metabolic control in either group. For those on home HD, a low Kt/V did not predict hospitalization, mortality, or technique failure, though it did for in-center patients. The authors concluded that the current Kt/V urea targets “have limited utility” for home HD.
Read the abstract » | (added 2018-02-15)
Peritoneal Membrane Transport and Survival on PD
Among 470 PD patients followed for up to 10 years, high transporters were stable for the first few years, and after 5 years or so, PD adequacy began to slowly fall. The rate of PD transport did not affect patient survival.
Read the abstract » | (added 2018-01-11)
Tags: High Transporters, PD Adequacy, PD Transport, Patient Survival
Connecting Home HD Patients to Care Teams Reduces Dropout
Nx2me is a telehealth platform that allows patients who use NxStage machines for home HD to send data to and communicate with their care teams. Compared to matched controls, 606 Nx2me users were more likely to successfully complete training and less likely to drop out of home HD.
Read the abstract » | (added 2018-01-11)
Tags: Nx2me, Telehealth, NxStage Machines, Home HD
A View of the Dialysis Bundle from a Home Perspective
Don’t miss Dr. Tom Golper’s fascinating take on how the CMS bundle for dialysis services affects home treatments.
Read the abstract » | (added 2018-01-11)
Tags: CMS, Home Treatments
New UK PD Guidelines
Download a free, full-length PDF if you want to learn how PD equipment, training, dose, infection control, and management of complications are done in the UK.
Read the abstract » | (added 2017-12-14)
Tags: PD Equipment, PD Training, Infection Control, PD Dose, PD Complications Management, UK
In-hospital Patient Education Helps “Crash” Dialysis Starts to Consider PD
As many as half of people who start dialysis in the U.S. each year “crash” into a need for treatment with an urgent, unplanned start—and most receive HD with a catheter. The same is true in Germany, but a new structured education program changed the pattern. Compared to patients who started dialysis urgently before the program, those who were educated were significantly more likely to choose PD.
Read the abstract » | (added 2017-12-14)
Tags: Dialysis, Choose PD, PD Education