Self-locating catheters (SLC) vs. straight Tenckhoff catheters for PD

Which is better to reduce complications: an SLC designed to avoid trapping the tip against the abdomen wall? Or, a single cuff, straight Tenckhoff catheter? In a series of 78 people new to PD, 40 were given SLCs and 38 were given Tenckhoffs. Prior to the start of PD, there were no differences between the groups. But, once PD began, there were fewer problems in the SLC group (p=0.021). Plus, it was easier to solve problems with SLCs using laxatives, and no surgeries were needed.

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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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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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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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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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)

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Should PD catheters be fixed in place?

PD catheters that migrate may need to be moved or replaced. In a new study from Japan, 16 patients had the usual PD catheter placement, and 25 had their catheters placed using a fixation technique. The fixed catheters were far more likely to be in the right position, and less likely to move out of position. Complication rates were similar for both groups.

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

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HD recovery time predicts survival (DOPPS)

In a finding with important implications for longer and/or more frequent HD, 6,040 in-center HD patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) were asked “How long does it take you to recover from a dialysis session.” The shorter the recovery time, the lower the risk of hospitalization and death.

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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Ferritin levels may predict residual renal function (RRF) drop on PD

Besides being an iron storage protein, ferritin is also a marker of inflammation. In a new study from Korea, the ferritin levels and RRF were measured in 123 people on PD. Those whose ferritin levels were high (>250 ng/mL) had significantly greater loss of RRF than those with lower ferritin levels. Multiple linear regression pointed to ferritin levels as an independent risk factor.

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

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