Journal Watch

  • Home therapies: Better outcomes

    A review article suggests that outcomes for PD and home HD are as good—or better—than those for standard in-center HD. PD use in the US has grown after the Medicare bundle created an incentive for its use. Home therapies are effective and patient-centered treatments.

    Read the abstract » | (added 2014-10-07)

    Tags: Home dialysis

  • Biocompatible PD fluid may preserve long-term residual kidney function

    A metaanalysis of 11 studies (n=1,034) found that biocompatible PD fluid did not boost residual kidney function (RKF) in the short term. But, at 12 months or more, there was a long-term preservation of RKF.

    Read the abstract » | (added 2014-10-07)

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  • PD catheter tunnel and exit site infections more likely with poor glycemic control—but not peritonitis

    Diabetes is known to raise the risk of infection. A study that looked back at blood sugar levels of 183 people new to PD, those with poor glycemic control had almost twice as many catheter tunnel and exit site infections, and had a first infection much sooner (p = 0.004). But, there was no increase in the risk of peritonitis.

    Read the abstract » | (added 2014-10-07)

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  • Home HD access survey

    A survey of consumers and clinicians on vascular access practices for home HD found that nurses were not following their own training procedures or using generally accepted procedures (GAP) to cannulate—and consumers were reluctant to report some signs and symptoms of access infection. Not one nurse or consumer had followed all of the GAP steps. (Editor’s note: This may help explain the high—and preventable—infection rate reported with the Buttonhole technique...)

    Read the abstract » | (added 2014-09-05)

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  • Home HD in people over age 65

    As MEI has noted in our MATCH-D tool, age alone should not be a contraindication for home PD or HD—and a new study shows this. In an international, multi-center study of 79 people over age 65 at dialysis initiation, event-free survival on home HD was 85% at 1 year, 77% at 2 years, and 24% at 5 years, with technique survival of 92%, 83%, and 56%, respectively. Just over half (54%) needed a helper for home HD.

    Read the abstract » | (added 2014-09-05)

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  • Men on PD fare worse with high serum uric acid levels

    In a study of 985 people using PD in China followed for more than 2 years, men in the highest tertile for serum uric acid were at the highest risk of death. The results were adjusted for age; BMI; comorbidities; residual kidney function; total Kt/V; use of allopurinol, ACE-inhibitors and ARBs; Hgb, serum albumin, creatinine, calcium and phosphorus, triglycerides, LDL cholesterol, and high-sensitivity C-reactive protein.

    Read the abstract » | (added 2014-09-05)

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  • Tolvaptan may boost urine output for people on PD

    A drug called tolvaptan nearly doubled the average urine volume and reduced the need for PD fluid volume by about 5000 mL weekly in a small trial of 11 people. The medication did not affect Kt/V, serum sodium, or serum albumin.

    Read the abstract » | (added 2014-09-05)

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  • VOLUME FIRST to improve outcomes in people on HD

    We try to include only HOME dialysis abstracts—but when the Chief Medical Officers of most of the US dialysis clinics agree on key messages to improve care, we need to summarize their four key points. These are: (1) Normalizing extracellular fluid volume should be a primary goal of dialysis. (2) Fluid removal should be gradual and treatments should not routinely be less than 4 hours. (3) Keep dialysate sodium in the range of 134-138 mEq/L and avoid routine sodium modeling and hypertonic saline. (4) Counsel consumers to avoid salt in their diets.

    Read the abstract » | (added 2014-09-05)

    Tags: Home dialysis

  • For older patients, PD offers quality of life boost

    Compared to younger people, those over age 65 on PD reported better quality of life, even after adjustment for case mix and comorbidities. Levels of anxiety and depression were about the same between older and younger patients. Those who used a cycler for PD reported fewer symptoms. The authors conclude that “Patients across different age groups should be given non-biased information about both peritoneal dialysis modalities and individual preferences should be elicited and carefully considered by healthcare providers.”

    Read the abstract » | (added 2014-08-04)

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  • Home HD is cost-effective vs. in-center

    A review of six studies of dialysis costs between 2000 and 2014 found that contemporary home HD options (short daily HD and nocturnal HD) may have higher short-term costs, but offer long-term cost savings compared to in-center HD, due to lower staff costs and better health outcomes.

    Read the abstract » | (added 2014-08-04)

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