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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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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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.

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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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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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Peritoneal cavity model will help the study of fibrosis

Researchers have devised a model peritoneum that allows them to study the impact of PD on the cells. The model has a mesothelial layer, an endothelial layer, and a collagen membrane chamber. When used for simulated PD, various solutions had different effects on the cells—but reduced nitric oxide production seems to be a mechanism for fibrosis. This new tool may lead to new ways to prevent and treat peritoneal fibrosis.

Read the abstract » | (added 2015-09-11)

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Randomized controlled trial: group education aids options choice

Among 80 people with ESRD, receiving a group education class with their support person led to significantly higher knowledge of treatment options—and more positive attitudes toward hemodialysis and living donation—than usual care. At 2 year follow up, 49 had begun renal replacement therapy, and 34 had had a transplant, of which 22 were preemptive.

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Kinetic modeling helps predict best PD prescription

Researchers found 12 subgroups among 1,005 people on PD, based on their membrane transport and amount of body water. Using PD Adequest 2.0, patients each had a PD prescription tailored to reach a minimum adequacy target for urea and water, using glucose and icodextrin fluids. A cut-off of more or less than 2mL/min of residual kidney function was identified. Use of icodextrin simplified the regimen and reduced glucose exposure and PD fluid volumes.

Read the abstract » | (added 2015-09-11)

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CRP levels and abdominal CT scans can find EPS early

A look back at CT scans and c-reactive protein levels from 30 people diagnosed with encapsulating peritoneal sclerosis has provided clues for early diagnosis. Higher than normal levels of c-reactive protein plus abnormal CT scan results found the rare complication early 78% to 87% of the time—making effective treatment more possible.

Read the abstract » | (added 2015-09-11)

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Home HD has 20% lower all-cause mortality than PD

In a new study that matched 4,201 new home HD patients in the USRDS database to new PD patients, the risk of all-cause mortality was 20% lower with home HD. In addition, there was an 8% lower risk of hospitalization, and a 37% lower risk of technique failure.

Read the abstract » | (added 2015-09-11)

Tags: Home dialysis