Meta-Analysis: Longer Dialysis, Better Pregnancy Outcomes

A new metaanlysis analyzed 190 papers and 25 abstracts covering 681 pregnancies in 647 women on dialysis. Meta-regression analysis found that more hours of HD per week was associated with a lower rate of preterm delivery, and that more dialysis sessions per week was associated with larger birthweight babies. Case reports suggested fewer small for gestational age babies with HD than with PD. No increased risk of birth defects was found.

Read the abstract » | (added 2015-12-10)

Tags:

Home HD Has Shorter Recovery Time After Treatment Than In-Center HD

A UK study asked 288 people “how long does it take for you to recover from an HD session?” Compared to a mean of 193 minutes (3+ hours) for the 197 people dialyzing in-center, the 91 home dialyzors had a mean of 67.3 minutes (just over an hour). While conventional home HD vs. intensive home HD had similar results, those who made more urine recovered faster.

Read the abstract » | (added 2015-12-10)

Tags:

What Predicts Transfer to Home HD After PD Failure?

In Australia and New Zealand, an analysis of all 10,710 patients treated with PD between 2000 and 2012 found that 2,915 transferred to HD—but just 156 started home HD. Among those who switched to home HD, more were male, obese, and had done PD longer. Older patients, those who stopped PD due to infection, who were underweight, whose ESRD was due to hypertension or diabetes, and those who were Aboriginal were less likely to go home.

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

Tags:

Trial of a Virtual Home HD Ward

Transitions from hospital stays back to home can lead to gaps in care. In Toronto, a virtual ward (VW) has been tested to see if care can be made more seamless. Following hospital discharge, a procedure, an antibiotic prescription, and/or completion of home dialysis training, patients were followed in the VW for 14 days. A nurse looked for the need for an HD prescription change, coordination of follow-up care, and medication changes. Care gaps were found in 67% of the 52 VW admissions for a total of 85 gaps. The researchers concluded that using a VW is practical, feasible, and identifies gaps that can be addressed.

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

Tags:

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)

Tags:

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)

Tags:

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.

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

Tags:

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)

Tags:

Hydrogen Sulfide Reduces Peritoneal Fibrosis in Rats

Hydrogen sulfide has helped fibrosis of the lungs, liver, kidneys, and heart. In this study, peritoneal fibrosis was induced in rats. Using hydrogen sulfide decreased inflammation and fibrosis, and improved peritoneal function, and may become a future treatment to help people.

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

Tags:

Encapsulating Peritoneal Sclerosis Increases with Time on PD

EPS is a devastating PD complication that can be lethal. An Italian clinic looked back at 30 years worth of data and found EPS prevalence rates of 2.8% overall among 920 patients: 0.4% for <2 years of PD, 3% at 2-4 years, 4% at 4-6 years, 6% at 6-8 years, 8% at 8-10 years, 75% by 12-14 years, and 67% for those with 14+ years of PD. Steroid treatment helped reduce mortality.

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

Tags: