Journal Watch

  1. Kt/V Urea Should NOT Be Used as an Adequacy Measure for PD

    Since the National Cooperative Dialysis Study, PD adequacy attention has focused on urea clearance, rather than on the more important benefit of middle molecule clearance. In this opinion piece, Dr. Joanne Bargman asserts that the PD community “made a mistake” adopting urea kinetics to the peritoneal dialysis process,” an error that continues to this day despite the lack of evidence linking Kt/V to outcomes in PD patients.

    Read the abstract » | (added 05/12/2016)

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  2. Glycated Albumin More Accurate in PD than Glycated Hemoglobin

    Using hemoglobin A1c levels to assess glycemic control in people with diabetes using PD is risky, because anemia causes false negative results. In a 6-month study, 20 people with diabetes using HD were matched for age, sex, and post-meal glucose levels with people with diabetes using PD. In a multiple regression analysis, glycated albumin was the only independent predictor of plasma glucose levels.

    Read the abstract » | (added 05/12/2016)

    Tags: Hemodialysis

  3. Metaanalysis of Patient Education and Choice of PD

    An analysis of 15 studies (including one randomized controlled trial and 9 observational studies) found that patient-targeted education tripled the odds that patients would intend to use PD as a first treatment option.

    Read the abstract » | (added 05/12/2016)

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  4. Starting PD with Three Exchanges

    Are four PD exchanges magical? Or could new patients thrive with three exchanges per day, at least for a while? In a new study, 46 incident PD patients began treatment with three exchanges. During the 2 years of the study, 25% received a kidney transplant. Most were able to use three exchanges for a mean of 24 months before needing a fourth, and there was less loss of residual kidney function than in the predialysis period prior.

    Read the abstract » | (added 05/12/2016)

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  5. Urea Alone is Not a Good Index of Dialysis Dose

    All-cause mortality in the HEMO study was not significantly related to removal of small solutes in short, intermittent, standard HD. “Failure to achieve greater reductions in solute levels may explain the failure of high Kt/V urea treatment to improve outcomes,” the authors note. (Yet another reanalysis of the HEMO study data has confirmed the obvious…)

    Read the abstract » | (added 04/12/2016)

    Tags: Hemodialysis

  6. Survival on PD vs. Daily Home HD

    A USRDS study matched 3,142 people starting daily home HD with 2,688 starting PD and compared survival. Those who were doing short daily HD had 12.7 deaths per 100 patient years, vs. 16.7 in the PD group.

    Read the abstract » | (added 04/12/2016)

    Tags: Hemodialysis

  7. If One PD Exit Site Antibiotic is Good, Are Two Better?

    In a single center study, 146 people on PD were randomized to use gentamycin cream on their exit sites (n=71) or to switch between gentamycin in odd months and mupirocin in even months (n=75). After 174 (gentamycin) or 181 patient years (alternating), the group switching between two antibiotics had significantly more peritonitis, especially gram-negative and fungal.

    Read the abstract » | (added 04/12/2016)

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  8. Loss of Kidney Function Slowed After Starting PD

    In 77 new PD patients, the rate of decline of kidney function was significantly slower after they started PD than it was when they were predialysis (p<0.01).

    Read the abstract » | (added 04/12/2016)

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  9. Milk Thistle Extract Improved Hemoglobin and Albumin in PD

    Silymarin is an antioxidant. Among 50 people on PD randomly assigned to take silymarin (n=28) or a control (n=22) for 2 months, those who took the supplement three times a day had significantly higher antioxidant levels. They also had significant increases in hemoglobin and albumin levels at the p<0.05 level. (NOTE: Always inform a nephrologist of any supplement use.)

    Read the abstract » | (added 04/12/2016)

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  10. PD Catheter Placement: Does Timing Matter?

    Do patients who are able to wait 14 days before using a PD catheter have less peritonitis than those who use it sooner? Can they do PD longer? Do they live longer? There were no significant differences in any of these parameters, finds a new observational study of 149 patients, 80 early and 69 delayed. (NOTE: This is good news for early start PD.)

    Read the abstract » | (added 04/12/2016)

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