Journal Watch
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Emergent Start PD Yet Again
Learn about the rationale and feasibility of using PD as a first dialysis option for emergent start patients instead of inserting a central venous catheter and starting HD. .
Read the abstract » | (added 2018-04-12)
Tags: End stage Renal Disease, Haemodialysis, Peritoneal Dialysis, Unplanned Start, Urgent Start
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Improving Incident ESRD Care with Transitional Care Units
Patients who transition onto dialysis are at high risk for morbidity and mortality—along with high costs. Transitional care units use the first 30 days of treatment for systematic onboarding that includes education and informed options choice—and may be especially helpful to those who start treatment emergently. Read the abstract.
Read the abstract » | (added 2018-03-16)
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Experiences of Self-cannulation in Men
Self-cannulation can be a barrier to home HD, and a new qualitative study examined why that is and how patient attitudes toward it changed over time. Eight male patients were interviewed, and the course of becoming a self-cannulator was described as a “process” of gaining control, building confidence, and finding a new norm. The article suggests practical techniques that can be used by clinic staff. Read the abstract
Read the abstract » | (added 2018-03-16)
Tags: Self cannulation, Techniques
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Homocysteine as a Marker for Spontaneous Bacterial Peritonitis
A non-invasive marker for SBP could save both time and money, and in a series of 323 PD patients with ascites, the ascitic fluid was tested for homocysteine levels. Both serum and ascitic levels were elevated in the SBP group—and both levels dropped after treatment. A cutoff level was suggested. Read the abstract.
Read the abstract » | (added 2018-03-16)
Tags: Ascites, Homocysteine Levels
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Nephrology Fellows Need Home HD Training & Experience
Home HD offers research and quality improvement topics for fellows, but lack of training is a barrier to patient use of this option. Fellows should attend lectures and receive at least 6-12 months of outpatient clinical exposure that includes transitioning three or more patients to home, argues a new op ed. Having a passionate home HD expert and advocate is essential, as is exposure to home HD nurses.
Read the abstract » | (added 2018-02-15)
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Standard Kt/V urea Targets Less Useful for Home HD
When patients do home HD more often than three times a week, do the Kt/V urea targets still predict outcomes? Not all that well, suggests a new study. Multivariate regression analysis of 109,273 standard in-center HD patients compared to 2,373 home HD patients found that while a lower Kt/V urea (<2.1) did predict higher blood pressure in both groups, it did not predict metabolic control in either group. For those on home HD, a low Kt/V did not predict hospitalization, mortality, or technique failure, though it did for in-center patients. The authors concluded that the current Kt/V urea targets “have limited utility” for home HD.
Read the abstract » | (added 2018-02-15)
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Year 1 Cognitive Function Better with PD than Standard In-center HD
PD came out the winner over standard in-center HD in a study of cognitive function among 96 HD and 101 PD patients who took cognitive tests at the start and end of their first year of treatment, though both groups saw some improvement.
Read the abstract » | (added 2018-02-15)
Tags: PD, HD, Cognitive Function
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Starting PD with One Daily Exchange of Icodextrin
Incremental PD can be less restrictive for patients initiating therapy. Is one daily exchange with icodextrin enough? A physiological study used a 3-pore kinetic model to assess fluid and solute removal among patients with residual function that ranged from 0 to 15 mL/min/1.73m2. All but very large patients (total body water >60L) were predicted to achieve adequate dialysis with this approach.
Read the abstract » | (added 2018-02-15)
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A New, Early Marker for Encapsulating Peritoneal Sclerosis?
Can a drop in dialysate sodium sieving during a PET forecast EPS in advance? A 20-year, controlled longitudinal cohort study found a correlation. Of 161 incident PD patients, 13 went on to develop EPS—and sodium was the best predictor.
Read the abstract » | (added 2018-02-15)
Tags: Dialysate Sodium Sieving, PET, EPS
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Avoiding Short-term HD with Lower PD Abdominal Pressure
When PD patients have hernias, leaks, surgeries, etc., they are often told that they must switch to HD temporarily—using a central venous catheter. Another approach, reducing intraabdominal pressure, may reduce the need for HD, decrease morbidity, and minimize cost.
Read the abstract » | (added 2018-02-15)
Tags: Hernias, Leaks, Surgeries, Intraabdominal Pressure