Glucose-sparing PD fluids improve glycemic control

Hemoglobin A1c levels can be inaccurate in people on dialysis. In the IMPENDIA trial using serum fructosamine levels corrected for serum albumin, patients who used PD were randomized to a glucose-sparing (n=89) or standard PD fluid (n=91). In the glucose-sparing group, fructosamine levels dropped significantly, while in the standard group, the levels increased slightly.

Read the abstract » | (added 2015-04-10)

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Metanalysis of low-glucose PD fluid and residual kidney function

An analysis of six randomized controlled trials of neutral pH, low-glucose PD fluids has found that patients who used these fluids had a much slower rate of residual kidney function loss and much higher weekly Kt/Vs than those using standard PD fluids. There were no significant differences between groups in ultrafiltration, blood pressure, or all-cause mortality.

Read the abstract » | (added 2015-04-10)

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On PD, less inflammation linked with longer survival

Among 87 people on PD, ages 30-85, who were followed for 30 months, the inflammation marker serum amyloid-A (SAA) was a significant independent predictor of mortality. When four markers of inflammation were analyzed together, SAA, age, and the presence of cerebrovascular insults were the strongest predictors.

Read the abstract » | (added 2015-03-11)

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To stop PD catheter migration: location, location, location

The “real estate” used for PD catheter placement matters in preventing catheter tip migration, a study finds. Compared to 98 people who received conventional left quadrant PD catheter placement, 139 whose catheters were placed in the right lower quadrant had significantly less catheter tip migration (19.3% vs. 3.6%; P<0.01) with similar inflow and outflow time, ultrafiltration volume, infection, hemorrhage, and obstruction rates.

Read the abstract » | (added 2015-03-11)

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More reasons to use PD fluid with less sugar

Using a novel index created by dividing the glucose content of PD solution by body weight, this study looked at the impact of PD fluid sugar on hemoglobin A1c, fluid overload, and inflammation (measured by interleukin (IL) 6) in 43 people on PD. Higher sugar levels were linked with worse diabetes control, more fluid overload, and higher IL-6 levels.

Read the abstract » | (added 2015-03-11)

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PD training: How much is enough to reduce peritonitis risk?

In a group of 2,243 patients from Brazil, two thirds with less than 4 years of education, training time mattered. After nearly a year of follow up, those whose training was less than 1 hour per session were more likely to have peritonitis. And, those who had at least 15 hours of training had significantly less peritonitis than those who had less. Having a care partner or training multiple people did not affect the risk. But, training before the catheter was placed or at least 10 days after did help.

Read the abstract » | (added 2015-02-10)

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PD training: How much is enough to reduce peritonitis risk?

In a group of 2,243 patients from Brazil, two thirds with less than 4 years of education, training time mattered. After nearly a year of follow up, those whose training was less than 1 hour per session were more likely to have peritonitis. And, those who had at least 15 hours of training had significantly less peritonitis than those who had less. Having a care partner or training multiple people did not affect the risk. But, training before the catheter was placed or at least 10 days after did help.

Read the abstract » | (added 2015-02-10)

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How patients and care partners feel about home HD

A review of 24 qualitative studies of home HD patients and care partners found five themes: feeling vulnerable, fear of being alone, concerns about family burden, opportunity to thrive, and appreciating medical responsiveness. Starting home HD seemed to be an especially anxious time. Acknowledging these themes and offering reassurance may help more people succeed on home HD.

Read the abstract » | (added 2015-02-10)

Tags: Home dialysis

Nocturnal home HD catheter sepsis rates similar to in-center

When 63 nocturnal home HD patients with catheters were matched 1:20 with standard in-center HD patients, both groups had similar rates of sepsis. The catheters lasted about the same length of time.

Read the abstract » | (added 2015-02-10)

Tags: Home dialysis

More Canadian patients use PD if their nephrologists place catheters

Among 3,886 people with CKD in Ontario and had a PD catheter placed, those whose nephrologists put in the catheter were 59% more likely to use PD. Even among those who did not end up doing PD, when a nephrologist placed a PD catheter, survival was 97%—vs. 73% when a radiologist put in the catheter.

Read the abstract » | (added 2015-02-10)

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