Journal Watch
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To Reinsert a PD Catheter or Not to Reinsert: That is the Question
Among 470 PD patients in Singapore, 92 required PD catheter removal. Of these, 39% had a second PD catheter placed, while the rest switched to HD. Patients who could not continue PD were excluded from the analysis. Survival was about the same in both groups. Surprisingly, those who required catheter removal due to infection were more likely to be able to continue PD than those who required it due to catheter malfunction.
Read the abstract » | (added 2019-05-15)
Tags: PD Catheter, HD, Catheter Remova
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NxStage HD and Removal of Beta-2 Microglobulin
Which works best to remove B2M, High-flux standard HD, post-dilution hemodiafiltration (HDF), NxStage short daily HD, or automated PD? In a small study (N=43), HDF and NxStage HD done 6 days per week removed the most B2M. Standard HD was next, with automated PD removing the least.
Read the abstract » | (added 2019-05-15)
Tags: B2m, High flux Standard HD, Post dilution Hemodiafiltration (HDF), NxStage Short Daily HD, Automated PD
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KDIGO Controversies: Dialysis Start and Modality Choice
A January 2018 Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference addressed significant variations between countries in dialysis start, patient preparation, and modality mix. Happily, attendees supported individualized care that incorporates patient goals and preferences (within quality and safety parameters), and the need to avoid a one-size-fits-all approach.
Read the abstract » | (added 2019-05-15)
Tags: Modality, Individualized Care, Patient Goals, Patient Preferences
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Operationalizing Telehealth for Home Dialysis
In January, 2019, Medicare rules for telehealth changed to permit the home as an originating site for home dialysis patients. ESCOs can take advantage of waivers to obtain payment for a monthly comprehensive telehealth visit with a home patient after the first 3 months of therapy—with no geographic restrictions. Technical, regulatory, and operational challenges are discussed in this article.
Read the abstract » | (added 2019-04-11)
Tags: Maintenance Dialysis Therapy, Telehealth Services, Legislation, Regulatory Requirements, Remote Monitoring
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Perspectives on Payment for More Frequent Home HD
This article explains the role of the Medicare regional contractors in implementing—or thwarting—payment for more than three home HD payments per week, and offers options for changing Medicare’s payment system to ensure that this option is supported.
Read the abstract » | (added 2019-04-11)
Tags: Medicare Regional Contractors, Medicare Payment System, HD Payments
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Three Diuretics are Better than One on PD
A small study (n=51) randomly assigned adult CAPD patients to receive three diuretics or just one plus placebo for 6 months. Among the 43 patients who completed the trial, those who took three diuretics had significantly better hydration status and more change in urine output—with no adverse events reported.
Read the abstract » | (added 2019-04-11)
Tags: Peritoneal Dialysis, Furosemide, Hydration Status, Hydrochlorothiazide, Spironolactone
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Cognitive Impairment Predicts PD Peritonitis
A prospective cohort study assigned 458 PD patients to a cognitively impaired (CI) or non-CI group based on results of mental state testing. The groups were not otherwise significantly different. Over 31.4 (median) months, 94 patients had first-time peritonitis, and short-term memory losses were independently linked with a higher risk.
Read the abstract » | (added 2019-04-11)
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Longer HD Treatments Do Not Make Up for the 2-day “Killer Gap”
For 20 years, the kidney community has known that death on HD is significantly higher on the day after the 2-day “killer gap.” An analysis of 250+ minutes vs. <200 minutes HD treatments found that even 4.5 hour long treatments thrice weekly did not make the gap less lethal.
Read the abstract » | (added 2019-03-12)
Tags: Treatment time, Interdialytic Interval, Hospitalization, Mortality
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HOW do AGE’s Cause Peritoneal Fibrosis?
For years, researchers have known that the advanced glycation endpoints (AGEs) that form when sugar-based PD fluid is made harm the membrane. But, we didn’t know why. Human cell modeling finds that AGEs cause outer layer peritoneal cells (epithelial) to become connective tissue cells (mesenchymal).
Read the abstract » | (added 2019-03-12)
Tags: AGEs, Mesothelial, Epithelial, STAT3
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Clues to Home HD Retention
Why do people drop out of home HD? A new interview study of 15 current and 10 former patients sheds some light. The study identified five themes, each with a positive and a negative aspect: degree of independence, support, technical aspects, home environment, and attitudes and expectations.
Read the abstract » | (added 2019-03-12)
Tags: HHD, Modality, Discontinuation