Journal Watch
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Home Dialysis Barriers Examined (Again)
Since the NKF-KDOQI is a latecomer to the home dialysis party (at least for home HD), they started at the beginning with a conference identifying barriers to starting and keeping patients at home. Not surprisingly, cursory education, and lack of exposure to home options or support for care partners were implicated.
Read the abstract » | (added 2019-01-11)
Tags: Home Dialysis, KDOQI, Barriers, Patient Support
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Longer-term Benefits of Early Start PD
Do people who start PD emergently differ from those with a planned PD start? No, suggests a new study of 154 patients followed for a median of just over a year. Early vs. planned-start patients had similar ages, BMIs, genders, and rates PD drop-out due to peritonitis, catheter dysfunction, and burnout. Only diabetes and BMI >25 were independently associated with PD technique failure—but no differences were found between early and planned starts.
Read the abstract » | (added 2018-12-14)
Tags: Emergent PD, Planned PD, Early Start PD
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Medicare Reimbursement Has Driven More PD
Changes to the Medicare Prospective Payment System (PPS) in 2011 to create financial incentives for PD have worked, finds a new analysis of 6,433 dialysis clinics before and after the change. Since 2011, 6% more clinics offered PD, and program size increased from an average of 5.7 patients to 6.9. Non-urban, chain, and larger clinics were significantly more likely to have changed their PD practices in response to the PPS change.
Read the abstract » | (added 2018-12-14)
Tags: Medicare, Prospective Payment System, Peritoneal Dialysis, Quality Of Life
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Wanted: A Paradigm Shift from Urea to Sodium Removal
When nephrology icon Zyblut Twardowski talks, we listen! When dialyzors in Seattle in the 1960s got 30 hours a week of dialysis, the mortality rate was 10%. Since then, short treatments—justified by the flawed NCDS study—were driven by the equally flawed notion of Kt/V urea.
Read the abstract » | (added 2018-12-14)
Tags: Kt/V Urea, Mortality Rate, Sodium Removal, Dialysis Quality, NCDS, RCT
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Icodextrin Reduces PD Stroke Risk
Stroke risk was compared in PD patients in Taiwan who did or did not use icodextrin. Icodextrin users had a lower risk and incidence of strokes than non-users.
Read the abstract » | (added 2018-12-14)
Tags: Stroke, PD Patients, Icodexytrin
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Protein Clearance Predicts Mortality on PD
Protein clearance on PD may be a marker of peritoneal inflammation. Among 711 PD patients followed for at least one year, each 10mL/day rise in protein clearance was linked with a 10.4% increase in the risk of all-cause mortality (p=0.008). Protein clearance was linked with serum albumin and C-reactive protein levels.
Read the abstract » | (added 2018-12-14)
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Uric Acid Levels and CAPD Mortality—an Unexpected Relationship
One might think that high uric (UA) levels would be harmful to those doing CAPD. But, a retrospective analysis of 492 PD patients found that all-cause, cardiovascular, and infection-related deaths dropped as UA levels rose.
Read the abstract » | (added 2018-11-11)
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How PD and In-center HD Patients Perceive Modality Choice
The Empowering Patients on Choices for RRT (EPOCH-RRT) study looked at patients' perceptions of how they chose a dialysis option and the impact of their choice on their lives. Among 1,346 in-center HD and 614 PD patients, those on PD were more likely to report that they had enough information, understood the options, made an active choice, and were happy with it. EDITOR’S NOTE: This study did not include home HD.
Read the abstract » | (added 2018-11-11)
Tags: Dialysis Modality, ESRD
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Biocompatible PD Fluids: A Systematic Review
Are neutral pH, low glucose degradation product (GDP), and icodextrin PD fluids better than standard ones? A Cochrane review of 42 studies (n=3,262 ) found that neutral pH and low GDP fluids significantly improved residual kidney function (RKF) vs. standard fluids—and more so over time, and urine volume was better preserved. Icodextrin boosted ultrafiltration without reducing RKF.
Read the abstract » | (added 2018-11-11)
Tags: Biocompatible, PD Fluid
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Brush Teeth to Avoid Peritonitis
Are neutral pH, low glucose degradation product (GDP), and icodextrin PD fluids better than standard ones? A Cochrane review of 42 studies (n=3,262 ) found that neutral pH and low GDP fluids significantly improved residual kidney function (RKF) vs. standard fluids—and more so over time, and urine volume was better preserved. Icodextrin boosted ultrafiltration without reducing RKF.
Read the abstract » | (added 2018-11-11)
Tags: Oral Hygiene, Peritonitis