Case Report: Thrombocytopenia with NxStage

Two patients have developed thrombocytopenia while using NxStage dialysis machines, perhaps due to electron-beam sterilization of the dialyzers. Switching to another machine resolved the problem; but it recurred in the patient who retried NxStage.

Read the abstract » | (added 2015-11-11)

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UK Identifies Ways to Boost Use of Home HD

Commissioners in the West Midlands, where home dialysis rates had been falling for 10 years, set a target for home dialysis uptake. Comparing this area’s seven hospitals with the rest of England for 3 years before and after the target found significant increases at the study hospitals. Use of financial penalities, adding funding for specialist staff and equipment, having visible champions, good systems for patient training, and ongoing healthcare support at home all helped. Lack of training for non-specialists, poorly developed patient education, and patients’ unmet emotional needs are ongoing challenges.

Read the abstract » | (added 2015-11-11)

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Vascular Access Technique Audits Can Reduce Home HD Access Infections

Self-cannulation errors can lead to infections. A retrospective study of all prevalent home HD patients at the University Health Network in Canada looked at access infections between 2006 and 2013. Among the 92 patients who completed at least one vascular access audit, those with five or more errors had significantly higher infection rates. Longer duration on home HD was associated with higher error rates. Audits give nurses a chance to retrain patients and reduce future errors and infections.

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Decision Support Helps Match Treatments with Preferred Lifestyles

In Spain, 569 of 1,044 patients in 26 hospitals who had to choose a renal replacement therapy (RRT) option between September 2010 and May 2012 used a decision aid to help them decide, and 399 started treatment. Those who did use a decision aid changed their minds significantly less often and were more likely to begin the treatment they chose. There was about a 50/50 distribution of PD and standard HD, and an increase in transplant interest as well—even among those with unplanned dialysis starts. See MEI’s U.S. decision aid, My Life, My Dialysis Choice.

Read the abstract » | (added 2015-11-11)

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PD Catheters: To Dress or Not to Dress?

Which is better for preventing exit site infections, a PD catheter dressing, or leaving a healed catheter open to the air? A prospective, randomized, controlled trial in Malaysia followed 108 patients for 2 years. All were instructed to wash the exit site daily with antibacterial soap. The dressing group (n=54) used povidone iodine, mupirocin ointment, sterile gauze, and tape. The non-dressing group did not. Of the 97 patients who completed the study, the results from both groups were similar.

Read the abstract » | (added 2015-10-15)

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HD Membranes and Bisphenol A (BPA) Blood Levels

BPA, an ingredient in many plastics and resins, can build up in the bodies of people with kidney failure. Studies suggest that BPA may be linked with kidney and heart damage. Compared to BPA-free polynephron dialyzers, patients dialyzed using conventional polysulfone dialyzers had higher blood levels of BPA, and higher markers of oxidative stress and inflammation.

Read the abstract » | (added 2015-10-15)

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Majority of Patients Open to Self-Care or Home HD if Trained Properly

A survey of 250 in-center HD patients and 51 nephrologists found that 69% of patients said they were “Likely” or “Very Likely” to consider self-care HD if they received proper training on a new machine designed for patient use. Nephrologists believed patients could do many dialysis tasks, but would not be willing to—responses that did not match what the patients said. Perhaps they should ASK?!

Read the abstract » | (added 2015-10-15)

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For Phosphorus Removal, Dialysis Time Matters

Dialysis guru John Daugirdas, coauthor of the Handbook of Dialysis, observes that “the most practical way to increase phosphorus removal is to extend dialysis, time” in this article, recommending 18-30 hours of HD per week to eliminate the need for binders. Other suggested interventions include use of more efficient dialyzers and possibly hemodiafiltration.

Read the abstract » | (added 2015-10-15)

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Simultaneous PD Catheter Removal and Replacement

A PD catheter can be replaced without interrupting PD, finds a new study in 55 patients with peritonitis, tunnel infection, or mechanical problems. Most used low-volume APD even on the day of surgery. Antibiotics were given for 2-4 weeks, and almost 90% of the procedures were done in an outpatient setting. Just one had a peritonitis recurrence, and no newly placed catheters were lost. Using the protocol allowed a median PD technique survival of 5.1 years and avoided the use of central venous catheters.

Read the abstract » | (added 2015-10-15)

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Excessive Weight Gain in Year 1 of PD Predicts Poor Outcomes

In a PLoS One study, 148 incident PD patients were observed for a median of almost 2 years. Those who gained more than 3% of their body weight lost residual kidney function 4.17 times faster (p<0.001), and had higher blood pressure, more inflammation, and an increased rate of diabetes.

Read the abstract » | (added 2015-10-15)

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