PD or In-Center HD: Which is Better for Transplant?

An analysis of 12 studies found that doing PD before a transplant had significanlty less delayed graft function than those who did standard in-center HD. While on dialysis, PD had better 5-year survival than standard HD, too. There were no differences in the rates of acute rejection or transplant survival. Watch a Video Journal Club of this study on 'Cappuccino with Claudio Ronco'

Read the abstract » | (added 2016-07-12)

Tags: Hemodialysis

PD Survival and Serum Sodium – Not What You Might Think

In an analysis of 4,687 people on PD between 2007 and 2011, those whose serum sodium levels were <140 mEq/L had a higher death rate than those with higher levels. Further studies are needed to see if correcting the sodium levels helps people live longer on PD.

Read the abstract » | (added 2016-07-12)

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For HD Survival, Home Beats In-Center

An observational study looked back at 41 incident patients starting home HD and matched them to patients starting in-center HD by sex, age, comorbidity, and start date. Mean survival on home HD was 17.3 years, vs. 13 years in-center. Home HD patients also had significantly lower phosphate levels and did not require blood pressure medications.

Read the abstract » | (added 2016-07-12)

Tags: Hemodialysis

Independence, Flexibility and Quality of Life Matter to Patients

For the PCORI-funded Empowering Patients on Choices for Renal Replacement Therapy (EPOCH-RRT), 180 people not yet on dialysis or using standard HD or PD were interviewed to identify the factors in their choice of a dialysis option. Independence, quality and quantity of life, and daily schedule flexibility mattered most—and 47% of those on standard HD said the choice had not been theirs. (NOTE: Ironically, the EPOCH-RRT decision aid omits home HD, an option that offers independence, quality of life, better survival, and schedule flexibility, as we have blogged here and here).

Read the abstract » | (added 2016-07-12)

Tags: Hemodialysis

Nocturnal HD Improves Nutritional Status

A metaanalysis was conducted of 9 studies with 229 patients who switched from standard to nocturnal HD. Those on nocturnal HD had significantly higher levels of serum albumin and protein and energy intake.

Read the abstract » | (added 2016-07-12)

Tags: Hemodialysis

Glucose in PD Solution Affects Non-Diabetic Patients, Too

Among 640 PD patients from three countries studied for up to 6.4 years, serum glucose levels rose with age and with higher dialysate glucose. In 5.4% of the sample, the levels suggested undiagnosed diabetes.

Read the abstract » | (added 2016-06-08)

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Outset Medical Tablo Human Factors Testing

Journal articles don’t tend to give product names, so we read between the lines to tell you that human factors testing on Outset’s Tablo home HD machine found 2.9 errors for patients—and 4.4 for nurses or technicians—out of 1,710 opportunities for error. None of the errors was safety related.

Read the abstract » | (added 2016-06-08)

Tags: Hemodialysis

More Inflammation With Standard HD Than With PD

Inflammation can lead to heart damage and poor outcomes. Two 3-month prospective studies with 228 HD and 80 PD patients measured two markers of inflammation: CRP and IL-6. In HD patients, these levels were both higher and more variable than in PD.

Read the abstract » | (added 2016-06-08)

Tags: Hemodialysis

Mechanisms of Peritoneal Membrane Fibrosis

Glucose in PD solution activates a cell protein in mice that typically prevents fibrosis when it is not activated. This pathway leads to inflammation, growth of new blood vessels, and fibrosis—so finding a way to switch it off could lead to new drugs to help prevent these problems.

Read the abstract » | (added 2016-06-08)

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Low Blood Magnesium Levels Risky On PD

Most magnesium in the body is not in the blood. And, very low blood levels (<1.8 mg/dL) were linked with higher rates of hospital stays and death among 10,692 people on PD. The greatest hospital risk was in patients who also had low (<3.5g/dL) serum albumin levels.

Read the abstract » | (added 2016-06-08)

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