Systematic Review of Pregnancy on HD

A new review summarizes 101 full papers and 25 abstracts and addresses the promise of successful pregnancy if enough HD is given.

Read the abstract » | (added 2016-11-10)

Tags: Hemodialysis

The HEMO Study Returns with a New Message

“An index only on the basis of urea does not provide a sufficient measure of dialysis adequacy,” finds yet another reanalysis of the by-now-ancient HEMO study data. Looking only at small uremic solutes—even non-urea wastes—did not predict all-cause mortality. Doing HD just three times a week made it impossible to remove enough solutes to matter.

Read the abstract » | (added 2016-11-10)

Tags: Hemodialysis

Time Matters: HD Kt Dose , Hospitalization, and Death

Does adding more HD benefit patients? Yes, finds a Fresenius study of 6,129 patients in Spain. There as a progressive increase in the risk of death for patients who were below the target Kt, and as Kt rose to reach and exceed the target, the risk declined, as did the risk of hospitalization. “Thus, prescribing an additional 3 L or more above the minimum Kt dose could potentially reduce mortality risk, and 9 L or more reduce hospitalization risk,” noted the authors.

Read the abstract » | (added 2016-11-10)

Tags: Hemodialysis

Why Seniors Choose HD vs. PD

Older people may be equally suited for PD or HD, so what guides their choice? In an interview study, PD was selected by those wanted convenience and a normal life. HD, on the other hand, was chosen by those who were afraid and wanted security. EDITOR’S NOTE: Of course patients are afraid! We need to help ease their fears before we educate them about their options.

Read the abstract » | (added 2016-11-10)

Tags: Hemodialysis

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