Journal Watch
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Fluid Management Risks of Incremental HD
Incremental HD critics worry that less-frequent treatments will lead to fluid overload—and they may be right. A sample of 23 patients had interdialytic weight gains (IDWG) analyzed in the first and last 3 months of twice-weekly (2x) HD and first 3 months of thrice-weekly (3x) HD. IDWG exceeded 5.7% of dry weight 0% in the first 3 months of 2x HD—12% in the last 3 months—and 4% after a switch to 3x. The authors said, “fluid management in incident-ESKD patients receiving bi-weekly HD deteriorates prior to conversion to thrice-weekly HD.”
Read the abstract » | (added 2019-08-14)
Tags: Incremental HD, Fluid Management Risks, Volume Management
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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
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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
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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
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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
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Half of PD patients may develop a new glucose disorder
A metaanalysis of nine studies with a total of 13,879 PD patients found that 8% had new-onset diabetes, 15% developed impaired glucose tolerance, and 32% had newly abnormal fasting blood sugar levels. No differences were found by ethnicity. The authors concluded that PD patients should receive glucose tolerance tests.
Read the abstract » | (added 2019-07-15)
Tags: PD, Diabetes, Glucose Tolerance, Blood Sugar Levels, Glucose Tolerance Test
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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
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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
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10-year retrospective study of urgent-start PD
Among urgent-start 2,059 PD patients followed for a decade, older patients were less likely to have PD catheter failure than younger ones, while men and people with diabetes had higher catheter failure rates. Lower hemoglobin levels predicted more abdominal wall complications. Overall, urgent-start PD was safe and effective, and a well-trained team and comprehensive follow up were recommended.
Read the abstract » | (added 2019-07-15)
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BMI and Survival on PD
A large study from Korea (N=80,674 PD patients) found that those in the highest group for BMI: just 25.71, had significantly higher all cause mortality.
Read the abstract » | (added 2019-06-13)
Tags: Body Mass Index, Survival, Diabetes Mellitus, Peritoneal Dialysis, Mortality