Timing of PD—is an early start harmful?

Early start HD (when eGFR is >10.5 mL/min/1.73m2) is not helpful, and may even be harmful. Is the same true of PD? No, suggests an observational study of 8,047 incident PD patients in Canada. Overall mortality was not higher for early, middle, or late start PD. However, first-year mortality was 38% higher in the early start group than in the late start group.

Read the abstract » | (added 2014-05-06)

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Strict volume control on PD helps the arteries and heart

In a prospective observational study of 58 people on PD, there was no difference in echocardiogram findings between APD and CAPD. But, those who followed strict volume control had better blood pressure control, less arterial stiffness, and lower NT-pro-BNP levels (a marker of left ventricular function).

Read the abstract » | (added 2014-05-06)

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Cost of in-center vs. home HD

Home HD has better clinical and patient centered outcomes than standard in-center HD. Does it cost less, too? A systematic literature review from 2000-2014 found six relevant studies and concluded that home HD (including short daily and nocturnal) is more cost effective; higher start-up costs are recouped over the long term. In-center HD has higher staff costs and poorer outcomes.

Read the abstract » | (added 2014-05-06)

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Even one bout of peritonitis can permanently change the membrane

An analysis of 541 people on PD compared the membranes of those who did and did not have a bout of peritonitis. In those who did, small solute transport was faster, they absorbed more glucose from the PD fluid, and the ultrafiltration rate was lower than in people who did not have peritonitis.

Read the abstract » | (added 2014-05-06)

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An HbA1c mean glucose formula for PD

Glucose in PD solution changes HbA1c levels. Chinese researchers compared blood sugar and HBA1c levels of 305 people on CAPD, of whom 13 had type 1 diabetes and 161 had type 2. Using linear regression, the authors identified a formula to correct HBA1c levels for PD users.

Read the abstract » | (added 2014-04-09)

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High-sensitivity CRP levels predict technique and patient survival on PD

High C-reactive protein (CRP) levels suggest inflammation. Among 402 PD patients followed for 2 years, those with the lowest CRP levels were more likely to still be on PD and had better survival. Each 1 mg/L increase in CRP predicted a 1.4% higher risk of mortality.

Read the abstract » | (added 2014-04-09)

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Online educational modules for professionals boost home therapies

A 3-module package of web-based e-learning about home dialysis was developed and tested on 88 undergraduate health professionals in Australia. Matching pre- and post-educational attitudes revealed clear knowledge deficits at the start, and significant improvement (p<0.001) afterward.

Read the abstract » | (added 2014-04-09)

Tags: Chronic kidney disease

Which came first: the peritoneal glucose load index, or LVH?

Glucose load in 43 stable PD patients was calculated with a peritoneal glucose load index (PGLI) based on glucose in grams/Kg/day in the daily PD prescription. A PGLI of > 3 g/Kg/day was positively correlated both with hemoglobin A1c levels and with left ventricular mass (p<0.001). The authors conclude that safe levels for PGLI need to be studied further. But, while this seems very plausible, correlations are not causal...

Read the abstract » | (added 2014-03-07)

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Pregnancy may be safe and feasible in women with ESRD receiving intensive hemodialysis

In a comparison of 22 Canadian pregnancies and 70 US pregnancies among women on dialysis, intensive HD helped the Canadian women by a wide margin. Live birth rate in Canada: 86.4%. In the US? 61.4%. Mean pregnancy length in Canada: 36 weeks. In the US? 27 weeks. Women who dialyzed < 20 hours per week had just a 48% live birth rate—while those who dialyzed > 36 hours per week had an 85% live birth rate with few complications.

Read the abstract » | (added 2014-03-07)

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Short daily HD may reduce phosphate burden vs. standard HD

In a small study of short daily HD users (n=24) vs. standard in-center HD users (n=54), serum calcium, serum phosphorus, and PTH levels were similar between the two groups. But, levels of fibroblast growth factor 23—which may be a marker of cumulative phosphate burden in the body—were significantly lower with short daily HD (P<0.01).

Read the abstract » | (added 2014-03-07)

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