In the Netherlands, High-Dose HD Holds Up to Cost Scrutiny

Is high-dose HD cost-effective?  A new Dutch study finds that while conventional home HD (three treatments per week) may be the most cost-effective, since high-dose HD is twice as much treatment, "from a payer’s perspective, high dose HD should be offered as a home therapy to obtain its clinical benefits in a cost-effective manner."

Read the abstract » | (added 2016-10-13)

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US Home Dialysis Use by Racial and Ethnic Minorities

Are African Americans about 50% less likely to do home therapies across the entire US—or are certain states less well-represented than others?  An analysis of 369,164 Medicare fee-for-service dialysis patients was analyzed by state. African American patients were the least likely to use PD in every US region except Massachusetts. Across the US, all minorities were less likely to use home HD than Caucasians, but Asians were more likely to use home HD in the Midwest.

Read the abstract » | (added 2016-10-13)

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Patient Peritonitis Perspectives

Australian researchers conducted interviews with 29 current or past PD patients to gain insights into the prevention of peritonitis. The four themes identified were the constant need for vigilance, invading harm from infection, incapacitating lifestyle interference, and exasperation with hospitalizations. The authors concluded that education about peritonitis and lifestyle impacts of PD may be helpful.

Read the abstract » | (added 2016-10-13)

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Case Study Offers Hope for Successful EPS Treatment

Working on the hypothesis that encapsulating peritonitis has TWO causes (a deteriorating peritoneum and inflammation), researchers tried a new treatment approach—and it worked. Combining sirolimus, a low-dose corticosteroid, and intradialytic parenteral nutrition helped a patient.

Read the abstract » | (added 2016-10-13)

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PD Dose Needs Adjustment for Activity Level

Is one PD Kt/Vurea level the same in a sedentary older person as it is in an active younger one?  NO, finds a new study that looked at energy expenditure in 148 PD patients. Adjusting Kt for resting energy use showed that women received less PD than men, younger people received less PD than older ones, and working people received less PD than unemployed ones—among other significant differences.

Read the abstract » | (added 2016-10-13)

Tags: Hemodialysis

Personal Support Workers for Home HD

Oh, Canada. The Canadians are out ahead of the US in virtually every dialysis parameter and they innovate constantly. Now, they have introduced a concept that CMS threw out with the bathwater in the 1980s—assisted home HD. A pilot project to dialyze six patients at home with personal support workers projected that costs would still be lower than for in-center HD. Phase 2 of the project includes 8 hospitals and 67 patients.

Read the abstract » | (added 2016-09-14)

Tags: Hemodialysis

Considering Alternative Markers for Dialysis Dose

A new review article looks at the impact of longer and/or more frequent, high-dose HD on dialysis adequacy—and inadequacy. Some uremic solutes come from nutrient intake and others don’t. For nutrient-based solutes, the authors suggest using inorganic phosphorus and protein-bound wastes as markers to develop new dose measures. For non-nutrient based middle molecules, they suggest beta-2-microglobulin measurement.

Read the abstract » | (added 2016-09-14)

Tags: Hemodialysis

VIPs in Dialysis Modality Choice

Whose opinion matters most to patients when it comes time to make a dialysis decision? In New Zealand, at least, it’s the nephrologist—even though respondents thought it would be predialysis nurses. In fact, a 1-point increase in nephrologist decisional power increased the rate of home therapies by 6.1%.

Read the abstract » | (added 2016-09-14)

Tags: Hemodialysis

Risk Factors for Encapsulating Peritoneal Sclerosis (EPS)

In a study of 703 PD patients between 1980 and 2015 at two centers, the 44 who developed EPS were more likely to have had a history of peritonitis, which rose with the duration of time on PD. The use of biocompatible PD fluid reduced the risk.

Read the abstract » | (added 2016-09-14)

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Which Tidal PD Setting is Most Efficient?

A study of 5 different tidal prescriptions for automated PD (APD) were used with six low-average and six high-average transporters. There were significant differences in urea and creatinine clearance between the prescriptions.

Read the abstract » | (added 2016-09-14)

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