Journal Watch
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Pelvic Drainage + Catheter Removal May Aid Refractory Peritonitis
Complications of peritonitis can go on even after PD catheter removal. A retrospective review of 46 patients with refractory peritonitis over 12-years found that the 12 who’d had pelvic drainage with closed active suction devices had an 8% future complication rate, vs. 44% in those who did not. None of the active drainage group needed further drainage or open laparotomy, while 35% of the non-drainage group did.
Read the abstract » | (added 2015-11-11)
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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)
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RCT Finds that Ginger Supplements Lower Triglycerides in People on PD
A small (n=36), randomized, double-blind, controlled trial tested ginger supplements (1000 mg/day) vs. placebo in people on PD. After 10 weeks, serum triglycerides dropped by up to 15% from baseline in the ginger group, which may reduce cardiovascular disease risk. Total cholesterol, LDL-C, HDL-C, and Lp(a) levels did not change.
Read the abstract » | (added 2015-11-11)
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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)
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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)
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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)
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HD Membranes and Bisphenol A (BPA) Blood Levels
BPA, an ingredient in many plastics and resins, can build up in the bodies of people with kidney failure. Studies suggest that BPA may be linked with kidney and heart damage. Compared to BPA-free polynephron dialyzers, patients dialyzed using conventional polysulfone dialyzers had higher blood levels of BPA, and higher markers of oxidative stress and inflammation.
Read the abstract » | (added 2015-10-15)
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Urgent Start PD: Safe and Effective
The first Canadian group to try urgent start PD followed 30 patients for a total of 3 years. They found no peritonitis or exit site infections in the first 4 weeks after catheter placements, three minor leaks that were managed conservatively, and four catheter migrations that were relocated without the need for surgery. The researchers concluded that urgent start PD is safe and effective for people who need to start dialysis and do not have an access.
Read the abstract » | (added 2015-10-15)
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PD Catheters: To Dress or Not to Dress?
Which is better for preventing exit site infections, a PD catheter dressing, or leaving a healed catheter open to the air? A prospective, randomized, controlled trial in Malaysia followed 108 patients for 2 years. All were instructed to wash the exit site daily with antibacterial soap. The dressing group (n=54) used povidone iodine, mupirocin ointment, sterile gauze, and tape. The non-dressing group did not. Of the 97 patients who completed the study, the results from both groups were similar.
Read the abstract » | (added 2015-10-15)
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Excessive Weight Gain in Year 1 of PD Predicts Poor Outcomes
In a PLoS One study, 148 incident PD patients were observed for a median of almost 2 years. Those who gained more than 3% of their body weight lost residual kidney function 4.17 times faster (p<0.001), and had higher blood pressure, more inflammation, and an increased rate of diabetes.
Read the abstract » | (added 2015-10-15)
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