Journal Watch
Should Home Dialysis Be Mandatory for Suitable Patients?
Considering improved survival, dramatically better quality of life, and reduced cost, should home dialysis be the default option?
Read the abstract » | (added 2015-01-08)
Tags: Home dialysis
PD Catheter Placement with Nitrous Oxide
In a series of 87 patients, placement of PD catheters was done using nitrous oxide—including removal of the omentum and any adhesions. Just five patients required conversion to general anesthesia. After a year, 97.6% of the catheters were still working, and had not required any revisions.
Read the abstract » | (added 2015-01-08)
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Urgent start PD: Better for Budgets than Urgent Start HD
A number of studies have found that urgent start PD is safe. But, does it save money, too, vs. placing a central venous catheter? Yes, finds a new study that surveyed practitioners: first 90 days costs for urgent start PD were estimated at $16,398, while for urgent start HD, the tab was $19,352.
Read the abstract » | (added 2015-01-08)
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Is low blood sodium as harmful in PD as it is in HD?
Hyponatremia (low blood sodium levels) raise the risk of death in people who do standard in-center HD. A prospective observational study of 441 incident PD patients found a higher mortality risk among those who did PD, too. In fact, after 3 years, the 1/3 of study participants whose sodium was lowest had a 79% higher risk of death than those whose levels were higher.
Read the abstract » | (added 2014-12-09)
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Don’t trust glucometers on people using PD with icodextrin
Glucometer test strips can’t distinguish glucose from other sugars, like maltose. When icodextrin is used for PD in people with diabetes, standard glucometer use is risky. Blood glucose test results from glucometers can’t be trusted, and people may be given insulin they don’t need (which could cause coma or death). Three case reports show why this is the case—and the authors suggest using glucose-specific blood tests instead.
Read the abstract » | (added 2014-12-09)
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New PD catheter technique uses Amplatz dilators
A laparoscope paired with Amplatz dilators to form the skin tunnel was used in 100 people who needed a PD catheter. The omentum was trimmed if it was long, and adhesions were lysed when present. There were no exit site or tunnel infections with this technique, and no catheter cuff extrusions. No catheters migrated or were displaced—and 97% of the catheters were working 6 months later.
Read the abstract » | (added 2014-12-09)
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Emergent-start PD works!
It flat-out makes more sense for people who need dialysis emergently to do PD, if possible, than to start HD with a catheter. A new review suggests that emergent-start PD may have a higher risk of catheter problems—but not infection. On the other hand, emergent-start HD risks both catheter problems and infection. The authors conclude that emergent-start PD is a “feasible, safe, and efficient alternative.”
Read the abstract » | (added 2014-12-09)
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How to prescribe intensive home HD: A guide for the nephrologist
This article describes each of the types of intensive home HD, and offers prescription guidance from experts.
Read the abstract » | (added 2014-12-09)
Tags: Home dialysis
More protein intake with nocturnal HD—but no change in body composition
Among 11 people doing nocturnal HD, protein intake increased significantly compared to matched standard in-center HD controls. But, one year later, total body mass, fat-free mass, and fat mass did not change.
Read the abstract » | (added 2014-12-09)
Nocturnal HD reduces blood endotoxin levels
Endotoxin drives inflammation throughout the body. Which type of HD is most effective at reducing endotoxin in the blood? This study compared standard in-center HD (n=56) to short daily HD (n=20) and nocturnal HD (N=10). Endotoxin levels were highest when ultrafiltration rates were highest (standard in-center HD) and lowest among those doing nocturnal HD.
Read the abstract » | (added 2014-12-09)
Tags: Nocturnal Hemodialysis