Hypocrisy in Healthcare—Professional vs. Patient ESRD Modality Choices

An anonymous online UK survey of renal healthcare workers had 858 responses to two hypothetical questions about their own dialysis modality choice. While PD and home HD were strongly preferred, more than 80% of ESRD patients in the UK still receive standard in-center HD.

Read the abstract » | (added 2023-09-13)

Tags: Dialysis Modality, ESRD Modality

Outcomes with PD to HHD Compared to Direct HHD

Analysis of data from all patients who started PD or HHD in the first 90 days of kidney replacement therapy in Canada matched PD+HHD patients (n=163) 1:1 to incident HHD patients (n=711). Interestingly, while hospitalization risk was similar, clinical outcomes were better in the PD+HHD group.

Read the abstract » | (added 2023-09-13)

Tags: PD, HHD, Kidney Replacement Therapy, Clinical Outcomes

Incremental PD and Quality of Life

In a 4-year study (2015-2019) of adults starting PD and followed for one year, those who used incremental PD had better KDQOL physical composite, burden of kidney disease, and effects of kidney disease scores, as well as less hospitalization and lower mortality rates (non-significant).

Read the abstract » | (added 2023-09-13)

Tags: Incremental PD, KDQOL, Mortality Rate, Quality Of Life

Incremental PD and Patient Outcomes: Registry Data

Between 2007 and 2017, incremental PD use increased by 2.7% in the ANZDATA database. Most (67%) used the approach for one year or less. After controlling for patient and center variables, starting PD with incremental treatments reduced peritonitis risk and transfers to in-center HD, with no increase in mortality.

Read the abstract » | (added 2023-09-13)

Tags: Incremental PD, Incremental Treatments, Peritonitis, Mortality Rate

Intraperitoneal Pressure and Hernias

While it has long been believed that high intraperitoneal pressure (IPP) is a factor in hernia development, this notion had not been proven. A prospective observational study of 124 incident PD patients over a 10-year period suggests that the common wisdom was correct. Higher IPP at PD onset, older age, higher BMI, prior hernia, laparoscopic PD catheter placement, and technique failure were related to hernia formation.

Read the abstract » | (added 2023-09-13)

Tags: Intraperitoneal Pressure, IPP, Hernia, Incident PD, Hernia Formation Factors

Disparities in Access to PD

Per logistic regression of USRDS data from 2009 to 2019, the incident PD population more than doubled, with increases in PD use by seniors. There was a 5% increase in PD use by Hispanic people, but no difference in other races. Urban PD use also increased by 5%, and 7% for those in socioeconomically disadvantaged areas.

Read the abstract » | (added 2023-08-16)

Tags: Incident PD, PD Access, Disparity, PD Demographics

How Glucose Causes Peritoneal Fibrosis

Constant glucose exposure from PD dialysate often causes fibrosis that can make further PD impossible. High glucose causes chronic inflammation, interferes with lipid metabolism, and leads to angiogenesis and fibrosis. RAAS activation contributes to this process as well. There may be benefit to looking at the upstream pathways to see if there are ways to block fibrosis.

Read the abstract » | (added 2023-08-16)

Tags: High Glucose, PD Dialysate, Fibrosis

2023 AJKD Core Curriculum in Nephrology

Acute PD, more use of home treatments, and better peritoneal solute transfer models are part of the content of the new Core, which emphasizes the latest data for prevention and management of infectious and noninfectious complications of PD.

Read the abstract » | (added 2023-08-16)

Tags: Acute PD, Core Curriculum, Complications Of PD, Home Dialysis

Meta-analysis of Quality of Life by ESRD Treatment Modality

Analysis of 111 papers with more than 50,000 patients compared transplant, PD, home HD, and in-center HD for health-related quality of life outcomes. The rankings? Transplant, PD, home HD, in-center HD.

Read the abstract » | (added 2023-08-16)

Tags: Quality Of Life, ESRD, Treatment Modality

ISPD Proposes to Remove PD Toxin Clearance Targets

New ISPD Guidelines suggest that the focus of PD should be patient well-being—not lab values. This change would allow more people to do PD, and focusing on relieving uremic symptoms could help determine which solutes really do matter to quality of life.

Read the abstract » | (added 2023-08-16)

Tags: PD, Patient Well being, Lab Values, Uremic Symptoms, Quality Of Life